Premenstrual syndrome, or PMS, is a group of symptoms that are related to hormonal changes due to the menstrual cycle. About 40% have some symptoms of PMS and 7% suffer from severe symptoms.
During the first half of a menstrual cycle, an egg begins to grow and the ovary produces estrogen. At mid-cycle, the egg is released in a process called ovulation. After ovulation, the ovary begins to produce a second female hormone called progesterone. Progesterone is important in supporting an early pregnancy if one should occur. But it is also responsible for all of the symptoms of PMS.
The most common symptoms are:
- Mood changes including irritability, anxiety, low energy
- Abdominal bloating, fluid retention
- Breast tenderness
- Appetite changes including craving of sweets and salt
The diagnosis of PMS is made simply by taking a history. The symptoms usually appear 7-10 days before the period starts. Once the menstrual flow begins, the symptoms disappear. There are no blood tests to confirm the diagnosis. Having PMS does not mean you have a “hormonal imbalance”. In fact, the hormones are acting exactly as they were designed.
Treatment of PMS involves lifestyle changes as well as medications. For mild symptoms, calcium and vitamin B6 have been shown to be helpful. In addition, decreasing caffeine intake and exercise will alleviate bloating, headaches, and some mood changes.
For women with more significant symptoms, taking oral contraceptive pills can be curative. Birth control stops ovulation so the hormone responsible for PMS is not produced and the symptoms do not occur. For mood changes, a mild antidepressant can be taken during the last 10 days of the menstrual cycle.