Premenstrual Syndrome
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Premenstrual Syndrome

(PMS; Premenstrual Tension Syndrome; Premenstrual Dysphoric Disorder; PMDD; Late Luteal Phase Dysphoric Disorder)

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Premenstrual syndrome (PMS) is a disorder marked by physical and emotional symptoms. It affects women one or two weeks before the beginning of their menstrual period.

The Menstrual Flow

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The cause is unknown. A combination of environmental, metabolic, and behavioral factors may make women vulnerable to the hormonal changes linked to menstruation. A brain chemical, serotonin, may play a role in severe forms of PMS .

Risk Factors

These factors increase your chance of developing PMS. Tell your doctor if you have any of these risk factors:

  • Age: 25-40
  • Going off birth control pills
  • Major life stress
  • Depression


If you have any of these symptoms do not assume it is due to PMS. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

  • Irritability
  • Mood swings
  • Anxiety
  • Depression
  • Diminished self-esteem
  • Difficulty concentrating
  • Sleep problems
  • Appetite changes (sugar and/or salt cravings, overeating)
  • Weight gain
  • Fatigue
  • Bloating
  • Headache
  • Breast swelling and tenderness
  • Palpitations
  • Dizziness
  • Gastrointestinal upset
  • Diffuse muscle pain

Symptoms improve when bleeding starts (menstrual period).


Your doctor will ask about your symptoms and medical history, and perform a physical exam.

Keep a record of your monthly physical and emotional symptoms. These symptoms will likely occur 1-2 weeks before your menstrual period. You may have PMS when symptoms occur at the same phase of the menstrual cycle each month.


Many treatments have been used to relieve symptoms. No one treatment has been found to always be effective for all symptoms. Treating one or two symptoms may improve the whole syndrome. Treatments include:

Stress Management

Stress may be managed through lifestyle changes. Relaxation techniques, deep breathing, massage, music, and hot baths can also help reduce stress.

Dietary Changes

Dietary changes may be helpful. They include decreasing intake of salt, sugar, and caffeine. Caffeine is found in coffee, tea, cola, diet sodas, and chocolate. Eating small, frequent meals may also help.

Vitamins and Minerals

The following vitamin and mineral supplements might reduce PMS symptoms:

  • Vitamin E (400 IU)—may reduce breast tenderness
  • Calcium (1000 mg)—may decrease bloating, depression, and aches
  • Magnesium (400 mg)—may decrease pain, fluid retention, and improve mood
  • Manganese (6 mg)—may help control symptoms of menstrual pain

Regular Exercise

Research suggests that women who engage in moderate activity suffer less PMS-related symptoms than sedentary women.


Diuretics can reduce bloating and fluid retention. Prostaglandin inhibitors, such as Motrin , can relieve cramps, headaches, and muscle aches.

Oral Contraceptives

Combined oral contraceptives may help physical symptoms linked to PMS. You may need to try several brands before finding one that helps. Progesterone alone may also help some women.


Antidepressants, such as Zoloft and Prozac , are helpful in managing depression linked to PMS.

Sexual Activity With Orgasm

Sexual activity (including masturbation) may relieve aching muscles and sluggish circulation. It moves blood and fluids away from congested organs.


Women with severe PMS symptoms may benefit from cognitive (behavioral) therapy . Therapy may reduce negative emotions and enhance problem-solving skills in relationships. It may also manage obstacles, frustrations, and discomfort.


To help reduce your chance of getting PMS, take the following steps:


American College of Obstetrics and Gynecologists

The National Women's Health Information Center


The Society of Obstetricians and Gynaecologists of Canada

Women's Health Matters


Department of Obstetrics and Gynecology. US Department of Health and Human Services website. Available at: . Accessed June 15, 2008.

Frye GM, Silverman SD. Is it premenstrual syndrome? Keys to focused diagnosis, therapies for multiple symptoms. Postgrad Med . 2000;107(5).

Premenstrual syndrome. EBSCO DynaMed website. Available at: . Accessed October 14, 2005.

Premenstrual syndrome. National Library of Medicine website. Available at: . Accessed October 14, 2005.

Last reviewed December 2007 by Jill Landis, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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