PMS; Premenstrual dysphoric disorder; PMDD
Premenstrual syndrome (PMS) refers to a wide range of symptoms. The symptoms start during the second half of the menstrual cycle (14 or more days after the first day of your last menstrual period). These usually go away 1 to 2 days after the menstrual period starts.
The exact cause of PMS is not known. Changes in brain hormone levels may play a role. However, this has not been proven. Women with PMS may also respond differently to these hormones.
PMS may be related to social, cultural, biological, and psychological factors.
Most women experience PMS symptoms during their childbearing years. PMS occurs more often in women:
The symptoms often get worse in late 30s and 40s as menopause approaches.
The most common symptoms of PMS include:
Other symptoms include:
There are no specific signs or lab tests that can detect PMS. To rule out other possible causes of symptoms, it is important to have a:
A symptom calendar can help women identify the most troublesome symptoms. This also helps in confirming the diagnosis of PMS.
Keep a daily diary or log for at least 3 months. Record the:
This record will help you and your health care provider find the best treatment.
A healthy lifestyle is the first step to managing PMS. For many women, lifestyle approaches are often enough to control symptoms. To manage PMS:
Birth control pills may decrease or increase PMS symptoms.
In severe cases, medicines to treat depression may be helpful. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are often tried first. These have been shown to be very helpful. You may also want to seek the advice of a counselor or therapist.
Other medicines that you may use include:
Most women who are treated for PMS symptoms get good relief.
PMS symptoms may become severe enough to prevent you from functioning normally.
The suicide rate in women with depression is much higher during the second half of the menstrual cycle. Mood disorders need to be diagnosed and treated.
Make an appointment with your provider if:
Katzinger J, Hudson T. Premenstrual syndrome. In: Pizzorno JE, Murray MT, eds. Textbook of Natural Medicine. 5th ed. Philadelphia, PA: Elsevier; 2021:chap 212.
Magowan BA, Owen P, Thomson A. Heavy menstrual bleeding, dysmenorrhea and premenstrual syndrome. In: Magowan BA, Owen P, Thomson A, eds. Clinical Obstetrics and Gynaecology. 4th ed. Elsevier; 2019:chap 7.
Marjoribanks J, Brown J, O'Brien PM, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2013;(6):CD001396. PMID: 23744611 pubmed.ncbi.nlm.nih.gov/23744611/.
Mendiratta V, Lentz GM. Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder: etiology, diagnosis, management. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 37.BACK TO TOP
Review Date: 6/22/2020
Reviewed By: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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