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premenstrual syndrome

Alternative Names
premenstrual tension syndrome, PMS, premenstrual tension, premenstrual dysphoric disorder (PDD), late luteal phase dysphoric disorder (LLPDD)

Premenstrual syndrome, or PMS, is a term used to describe the physical and emotional symptoms that many women experience before a menstrual period. The symptoms go away shortly after the period begins. PMS symptoms are a normal and healthy consequence of normal functioning of the ovaries.

What is going on in the body?
Premenstrual symptoms are common. Up to 40 percent (40%) of women in their reproductive years are affected to some degree. Daily life and relationships can be affected. Severe impairment occurs in only 5 percent (5%) of women. No single cause has been found, but it is related to ovulatory cycles. After menopause, it is not a problem.

To be considered symptoms of PMS, symptoms must occur in the second half of the menstrual cycle. There must be least a 7-day period without these symptoms in the first half of the cycle. This will rule out psychiatric problems that last all month. The symptoms must occur in three consecutive cycles and must be severe enough to require medical advice or treatment.

Wide ranges of views exist about symptoms and about how to diagnose the condition. Some consider PMS to be one of the most common female health problems. Others view PMS as of little importance. To the woman with symptoms, these arguments do not matter. Women should receive evaluation and treatment.

What are the signs and symptoms of the condition?
More than 150 symptoms have been attributed to PMS. Some of the most common include:
  • abdominal discomfort and bloating
  • breast tenderness
  • headaches
  • clumsiness
  • changes in sleep habits from too much sleep to insomnia
  • fatigue, lethargy
  • mood swings, usually involving anger, loneliness and temper outbursts
  • social withdrawal
  • depression
  • low self-esteem
  • anxiety
  • acne flare-up
  • constipation or diarrhoea
  • painful menstruation, known as dysmenorrhoea
  • increased guilt feelings
  • increased fears or paranoia
  • over reaction to sensory stimuli, such as lights, touch and noises
  • altered daily activities
  • decreased desire to exercise
  • increased crying
  • changes in sexual desire, usually decreased
  • food cravings, increased appetite
  • back pain, general muscle pains
  • difficulty concentrating
  • forgetfulness, confusion
  • swelling of the extremities, called oedema
  • dizziness or vertigo
  • suicidal ideas
What are the causes and risks of the condition?
The cause of PMS is unknown but it is associated with ovulatory cycles, or monthly cycles during which the ovary produces and releases an egg. A hormonal component is suspected. Because symptoms vary, it is likely that there are many complex factors that lead to a woman's particular list of symptoms.

There are many theories that look at possible causes of PMS. One theory involves progesterone levels. Progesterone is a hormone involved in the menstrual cycle. Research has not proven a relationship between PMS and progesterone.

Other theories include disorders of the thyroid gland, hypothalamus and pituitary gland. As with progesterone, no abnormalities have been consistently found.

Deficiencies in some vitamins, minerals and other nutrients can cause symptoms of PMS. These deficiencies include magnesium, manganese, B vitamins, vitamin E and linoleic acid and its byproducts. Nutritional supplements have shown some promise in relieving symptoms thought to be connected to these deficiencies.

What can be done to prevent the condition?
Because the cause or causes are not known, there is no reliable prevention. Because ovulation is required for PMS symptoms to occur, oral contraceptives may prevent many symptoms. But oral contraceptives can worsen the symptoms for others. Other preventative measures may include:
  • eating a healthy diet
  • avoiding high carbohydrate meals
  • maintaining normal weight
  • participating in a regular exercise program
  • avoiding caffeine, alcohol and cigarette smoking
  • using anti-inflammatory medications as needed, such as mefenamic acid or naproxen.
  • ensuring adequate calcium intake daily (1,500 mg/day), which is equivalent to 3-4 glasses of milk
  • avoiding events that trigger symptoms, such as stress
How is the condition diagnosed?
There is no specific test for diagnosis of premenstrual syndrome. A detailed history of symptoms, which takes into account the peak time of symptoms and the resolution of symptoms after a menstrual cycle, is used. If other psychiatric disorders are involved, a referral to a counsellor or psychiatrist should be made.

What are the long-term effects of the condition?
After diagnosis and symptom-free treatment is started, most women get some relief. This may involve trying a number of different treatments.

What are the treatments for the condition?
A variety of treatment options are available and may be used simultaneously. These include:
  • dietary modification to a balanced healthy diet, low in salt and simple carbohydrates and high in fruits and vegetables
  • exercise at least three times a week
  • dietary supplements, such as calcium (1,000-1500 mg/day); magnesium (400 mg/day); manganese (6 mg/day); vitamin E (400 IU/day)
  • nonsteroidal anti-inflammatory drugs (NSAIDS), such as ponstan or naprogesic
  • antidepressants
  • oral contraceptives, or birth control pills
  • diuretics, or water pills, such as frusemide or hydrochlorothiazide
What are the side effects of the treatments?
Side effects of treatment depend on the agent used. These include:
  • calcium -- abdominal cramping, bloating, constipation
  • oral contraceptives -- nausea, vomiting, weight gain, headaches
  • NSAIDs -- stomach irritation, nausea, rash.
  • antidepressants -- irritability, diarrhoea, fatigue, sexual dysfunction, sleeping difficulties
  • diuretics -- low potassium levels, fatigue, increased urination
What happens after treatment for the condition?
For some women, symptoms may be so severe that treatment is needed in order to conduct daily activities. Changes in diet, exercise and stress reduction will assist the doctor in determining a treatment plan to obtain maximum relief.

How is the condition monitored?
The woman and her doctor monitor symptoms of PMS.

Author: Eva Martin, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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