Premenstrual Syndrome (PMS) Patient Information Fact Sheet

What is premenstrual syndrome?
It is thought that up to 90% of women may suffer from premenstrual syndrome (PMS) to some degree. You may also hear PMS referred to as premenstrual tension or PMT. The symptoms of PMS are both physical and emotional and vary in nature and severity according to the individual. Symptoms may begin 1–2 weeks before a period (menstruation) and are usually relieved when a period starts.

What are the symptoms of PMS?
Physical symptoms—Water retention (edema) is a common symptom and usually presents as temporary weight gain. Water retention can cause bloating of the abdomen so clothes may feel uncomfortably tight. Ankles and feet may also become puffy and fingers may swell causing rings and watches to become too tight. Fluid retention can also occur in the breasts, causing sensitivity and tenderness. This may be noticed when bras become tighter and any pressure on the breasts is uncomfortable. Headaches are a fairly common symptom of PMS and may present as a pain affecting the face, particularly around the sinuses, or as a band of pain around the head (tension headache). PMS causes an increased incidence of migraines in migraine sufferers, and some people may suffer from migraines only at this time of the month.

Some women may suffer from backache or a feeling of pelvic pressure. Many women notice that they develop acne during the week before their period. This often clears up when the period starts but can add to the general lowering effect of PMS on a woman's morale.

Psychological symptoms—A feeling of tension or irritability is often noticed in varying severity. Some women may become "snappy" and are quicker to lose their temper than usual. Others may suffer extreme tension and can even become physically violent. Some women feel unable to concentrate or may feel like crying for no reason. Depression is a common feature of PMS. It can occur very quickly and the woman may suffer from mood swings, so that she may feel happy one minute and depressed and miserable the next. Physical symptoms of PMS, such as bloating or acne, can add to an already low mood. Depression may become quite severe and may need to be distinguished from symptomatic depression, which affects the sufferer all the time and not just during the premenstrual phase. Some women may feel lethargic and tired when they are premenstrual, which may be partly due to depression.

What causes PMS?
The cause of PMS is still uncertain although it is thought to be related to the hormonal changes that occur around ovulation. One theory is that it is caused by a deficiency of progesterone but, while progesterone replacement therapy is effective treatment for many women, for others it is of no benefit. Many women with PMS have normal levels of progesterone. Another theory is that estrogen may interfere with the body's use of vitamin B6 (pyridoxine). This vitamin is responsible for the production of a chemical in the brain known as serotonin. An inadequate supply of serotonin can cause depression.

How is PMS treated?
Oral contraceptives may reduce the symptoms of PMS but only in a small number of women. Conversely, they can sometimes cause the symptoms to become worse. Physical symptoms can be eased with over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) and naproxen (Aleve). Vitamin B6 may be prescribed for PMS and can be purchased over the counter, but should not be used in high doses (over 50mg per day). Diuretics (water pills) may be prescribed to alleviate the symptoms caused by water retention. A few women may have elevated levels of the hormone prolactin and bromocriptine may be prescribed to suppress the action of the pituitary gland in releasing prolactin. There are other treatments that may be tried if PMS is severe—your doctor will discuss these options with you if appropriate.

Self-help measures

  • Restrict the amount of salt in your diet—this can help to prevent fluid retention in the body.
  • Cut down on alcohol and caffeine and drink plenty of water instead.
  • If you smoke, try to cut down or stop.
  • Take regular exercise.
  • Try relaxation techniques, such as yoga, meditation and massage—these can help to relieve tension.

Further information
The National Women's Health Information Center: www.womenshealth.gov/publications/our-publications/fact-sheet/premenstrual-syndrome.cfm

Last Reviewed: May 2013