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Premenstrual syndrome, abbreviated as PMS, is a term used to describe a group of physical, mental, and behavioral symptoms. These symptoms occur in the 2 weeks before a menstruating woman has her period.

What is going on in the body?

PMS occurs during the last 2 weeks of a woman's menstrual cycle. This phase starts with the release of an egg from the ovary and ends when the woman starts her period. The exact cause of PMS is unknown, but researchers have proposed the following causes:

• changes in kidney hormone levels, which cause water retention and weight gain
• deficiencies of minerals, such as calcium
• deficiencies of vitamins A, B6, and E
• dietary changes, such as high levels of sodium and simple sugars
• higher levels of estrogen, a female hormone
• higher levels of prostaglandins, which produce inflammation
• lower levels of endorphins, which are a part of the nervous system that naturally make a person feel more positive or euphoric
• lower levels of progesterone, a female hormone
• lower levels of serotonin, a hormone that influences mood

What are the signs and symptoms of the condition?

More than 150 symptoms have been attributed to PMS. The American College of Obstetricians and Gynecologists (ACOG) lists these symptoms as the most common:

• abdominal distress and bloating
• breast swelling
• fatigue
• food cravings
• headache
• irritability
• mood swings
• tension
• weight gain

What are the causes and risks of the condition?

PMS is reported in 85% of women who menstruate. However, only 5% to 10% of menstruating women are severely impaired by PMS. No one knows what makes PMS so severe in some women and mild in others.

What can be done to prevent the condition?

The following recommendations may help prevent PMS or relieve some of the symptoms.

• Eat a healthy diet that limits foods that are high in sodium, fat, caffeine, alcohol, and simple sugars.
• Get aerobic exercise on a regular basis.
• Get enough vitamins and minerals, especially calcium and magnesium.
• Use relaxation therapy and other stress management techniques.

Several herbal remedies, including chasteberry and black cohosh, have been reported to relieve PMS. Some scientific studies have been released that support these claims. As with any over-the-counter medication, a woman should discuss these remedies with her healthcare professional.

How is the condition diagnosed?

• absence of other disorders that may cause similar symptoms
• impairment of some part of the woman's life
• symptoms consistent with PMS that are restricted to the last 2 weeks of the menstrual cycle

ACOG recommends that a woman keep a diary of her symptoms for 2 to 3 consecutive months. She can then discuss the diary with the healthcare professional, who may order tests to rule out other conditions.

What are the long-term effects of the condition?

There are no significant long-term effects of PMS.

What are the risks to others?

PMS is not contagious. It poses no risk to others.

What are the treatments for the condition?

ACOG recommends the following lifestyle changes to relieve PMS symptoms:

• a diet high in complex carbohydrates, or starches, and lower in simple sugars
• nutritional supplements, such as calcium, magnesium, and vitamins E, B complex, and B6
• regular aerobic exercise
• stress reduction techniques, such as meditation and imagery

Medications used to treat PMS include the following:

• antidepressant medicines, such as fluoxetine (i.e., Prozac, Sarafem) that increase serotonin production
• benzodiazepine medicines, such as alprazolam (i.e., Niravam, Xanax) that lower anxiety
• danazol (i.e., Danocrine), a modified male hormone, which can decrease breast pain
• diuretics, such as spironolactone (i.e., Aldactone) and metolazone (i.e., Zaroxolyn), which help the body excrete excess water and salts
• hormones, such as nafarelin (i.e., Synarel) and leuprolide (i.e., Lupron), which block the release of eggs from the ovaries
• medicines that affect high prostaglandin levels, such as mefenamic acid (i.e., Ponstel), ibuprofen (i.e., Motrin, Advil), and naproxen (i.e., Naprosyn)

Gonadotropin-releasing hormone, also known as GnRH, agonists can be prescribed to prevent the release of the egg from the ovary. These medicines are used only in severe PMS that cannot be treated effectively with other medicines. Other medicines, such as lithium and oral contraceptives, have been used to treat PMS. However, they have not been proven effective in clinical trials.

What are the side effects of the treatments?

Medicines to lower prostaglandin levels can cause stomach upset and allergic reactions. Hormones can interfere with other body processes. Antidepressants and medicines to control anxiety can cause drowsiness, dry mouth, and allergic reactions. Diuretics can cause salt imbalances and dehydration. GnRH agonists can cause osteoporosis.

What happens after treatment for the condition?

For many women, treatment continues until they stop menstruating at menopause.

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare professional.