PREMENSTRUAL SYNDROME (PMS)

General Information

DEFINITION--Symptoms that begin 7 to 14 days prior to a menstrual period and usually stop when menstruation begins.

BODY PARTS INVOLVED--Gastrointestinal system; central nervous system; skin; reproductive system; breasts.

SEX OR AGE MOST AFFECTED--About half of all women experience PMS at some time--some very frequently. The peak incidence occurs between ages 25 and 40.

SIGNS & SYMPTOMS

• Nervousness and irritability.
• Dizziness or fainting.
• Emotional instability.
• Increased or decreased sex drive.
• Headaches.
• Tender, swollen breasts.
• Bloating, constipation, diarrhea or other digestive disturbances.
• Fluid retention that causes puffiness in the ankles, hands and face.
• Higher incidence of minor infections such as colds.
• Acne outbreaks.
• Decreased urination.

CAUSES--Unknown, but appear to be fluctuations in the circulating level of hormones (especially estrogen and progesterone). These fluctuations cause retention of sodium in the bloodstream, resulting in edema in body tissues including the brain. Increased levels of prostaglandin (a chemical) in the bloodstream may be a factor.

RISK INCREASES WITH

• Stress may precipitate.
• Caffeine and high fluid intake seem to worsen symptoms.
• PMS increases with age.
• PMS can occur with other disorders such as depression.

HOW TO PREVENT--No specific preventive measures. Try to avoid stressful situations at expected time of PMS. Also share your feelings and needs with a close friend or spouse.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.

APPROPRIATE HEALTH CARE

• Self-care.
• Doctor's treatment.

POSSIBLE COMPLICATIONS--Emotional stress caused by symptoms severe enough to disrupt a woman's life.

PROBABLE OUTCOME--Present treatments may or may not be effective. Medication can relieve some symptoms. However, many new treatments are in the experimental stage, offering hope for the future.

How To Treat

GENERAL MEASURES--

• Treatment steps may involve diet, exercise and lifestyle changes. There are no medications clearly indicated for PMS.
• Reduce stress whenever possible (see How to Cope with Stress in Appendix).
• Learn relaxation techniques. Cut back on your schedule during these days if feasible.
• Stop smoking.
• Join a support group. Talking about your PMS problems with others can help.
• See Resources for Additional Information.

MEDICATION--Ask your doctor. These are used with varying degrees of success:

• Tranquilizers or sedatives to relieve tension.
• Nonsteroidal anti-inflammatory drugs to decrease prostaglandin levels.
• Diuretics to reduce fluid retention.
• Pain medications such as acetominophen or ibuprofen.
• Vitamin B-6, vitamin E, magnesium.
• Bromocriptine for breast tenderness (rare).
• Antianxiety drugs.
• Danazol for total symptom complex.
• Oral contraceptives may help.
• Other medications are undergoing study and may be more effective.

ACTIVITY--

• Begin a regular, aerobic exercise program (walking, biking, etc.).
• Get enough sleep at night.

DIET--

• Decrease salt intake during the premenstrual phase.
• Eat a low-fat, high- complex carbohydrate diet.
• Eat frequent small meals.
• Limit intake of caffeine (coffee, soft drinks, tea and chocolate). Abstain from alcohol.

Call Your Doctor If

• You have symptoms of PMS that interfere with normal activities or relationships, and self-care is not sufficient.
• Symptoms don't improve, despite treatment.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.