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PMS common, but extreme symptoms rare

Date: 8/1/2011

By James N. Martin Jr., MD, Congress of Obstetricians and Gynecologists

Breast tenderness, headache, bloating, weight gain — all are common physical symptoms that women experience in the days before their period begins. During this time, some women also report bouts of depression, angry outbursts, irritability, anxiety, confusion, and social withdrawal.

But while nearly 85 percent of reproductive-age women undergo one or two of these premenstrual symptoms, only 5 to 10 percent experience significant lifestyle impairment because of diagnosed premenstrual syndrome (PMS). Beginning in the days before menstruation and ceasing shortly after its start, women with PMS face symptoms severe enough to affect work, personal relationships, and daily activities.

PMS may start any time after menstruation begins and can last until menopause. The causes are unknown, but PMS is linked to changes in the levels of estrogen, progesterone, and testosterone in the body. These hormones guide the build-up of the lining of a woman’s uterus, the release of a mature egg, and the shedding of the uterine lining if pregnancy does not occur.

Because PMS can mimic other conditions, it’s important for your doctor to understand the kind of symptoms you have and when they happen. Keeping a symptom record for at least two months — listing the date and type of symptom and its intensity — may reveal a pattern directly related to the start and end of your period.

A very small percentage of women suffer from premenstrual dysphoric disorder (PMDD), an extreme form of PMS that can put a major strain on a woman’s personal and professional life. Tell your doctor if you have five or more of the following symptoms near your period: feeling depressed, tense, anxious, edgy, or overwhelmed; moodiness or frequent crying; constant irritability and anger that cause conflict with other people; lack of interest in things you used to enjoy; low energy levels; appetite changes, overeating, or cravings; trouble sleeping or sleeping too much; or joint or muscle pain and bloating.

To help relieve PMS symptoms, your doctor may recommend that you get aerobic exercise, eat a diet high in complex carbohydrates, or take nutritional supplements such as calcium, magnesium, or vitamin E. Selective serotonin reuptake inhibitors (SSRIs) — medications usually prescribed for depression — have also been shown to improve symptoms. Hormonal therapies, other medications such as spironolactone, and surgery may be effective in treating PMS in women who do not respond to SSRIs or lifestyle changes, but they may cause more side effects. Talk to your doctor about available treatment options.

For more information, the ACOG Patient Education Pamphlet “Premenstrual Syndrome” is available in English and Spanish at

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