Premenstrual syndrome

Introduction
Signs and Symptoms
Causes
Risk Factors
Screening and Diagnosis
Treatment

Mood swings, tender breasts, a swollen abdomen, food cravings, fatigue, irritability and depression. If you experience some or all of these problems in the days before your monthly period, you may have premenstrual syndrome (PMS).

An estimated three of every four menstruating women experience some form of premenstrual syndrome. These problems are more likely to trouble women between their late 20s and early 40s, and they tend to recur in a predictable pattern. Yet the physical and emotional changes you experience with premenstrual syndrome may be more or less intense with each menstrual cycle.

Still, you don't have to let these problems control your life. In recent years, much has been learned about premenstrual syndrome. Treatments and lifestyle adjustments can help you reduce or manage the signs and symptoms of premenstrual syndrome.

For many women the signs and symptoms of premenstrual syndrome are an uncomfortable and unwelcome part of their monthly menstrual cycle. The most common physical and emotional signs and symptoms associated with premenstrual syndrome include:

• Weight gain from fluid retention
• Abdominal bloating
• Breast tenderness
• Tension or anxiety
• Depressed mood
• Crying spells
• Mood swings and irritability or anger
• Appetite changes and food cravings
• Trouble falling asleep (insomnia)
• Joint or muscle pain
• Headache
• Fatigue

Although the list of potential signs and symptoms is long, most women with premenstrual syndrome experience only a few of these problems.

For some women, the physical pain and emotional stress are severe enough to affect their daily routines and activities. For most of these women, symptoms disappear as the menstrual period begins.

But for some women with premenstrual syndrome, symptoms are so severe they're considered disabling. This form of PMS has its own psychiatric designation - premenstrual dysphoric disorder (PMDD). PMDD is a severe form of premenstrual syndrome with symptoms including severe depression, feelings of hopelessness, anger, anxiety, low self-esteem, difficulty concentrating, irritability and tension. A number of women with severe PMS may have an underlying psychiatric disorder.

Exactly what causes premenstrual syndrome is unknown, but several factors may contribute to the condition. Cyclic changes in hormones seem to be an important cause, because signs and symptoms of premenstrual syndrome change with hormonal fluctuations and also disappear with pregnancy and menopause.

Chemical changes in the brain also may be involved. One clue to the cause may be traced to fluctuations of serotonin, a brain chemical (neurotransmitter) that is thought to play a crucial role in mood states, especially depression. Insufficient amounts of serotonin may contribute to other symptoms of PMS, such as fatigue, food cravings and sleep problems.

Occasionally, some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms associated with premenstrual syndrome. Stress also may aggravate some of the symptoms, but alone it isn't a cause.

Some PMS symptoms have been linked to low levels of vitamins and minerals. Other possible contributors to PMS include eating a lot of salty foods, which may cause fluid retention, and drinking alcohol and caffeinated beverages, which may cause mood and energy level disturbances.

Every month an egg usually is released from the ovary during ovulation. It travels down the fallopian tube, where it may be fertilized by a sperm. If fertilized, the egg usually implants in the lining of the uterus. If not, the egg and lining are shed during menstruation.

Your doctor may prescribe one or more medications for premenstrual syndrome. The success of medications in relieving symptoms varies from woman to woman. Commonly prescribed medications for premenstrual syndrome include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). Taken before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve) can ease cramping and breast discomfort.
• Oral contraceptives. These stop ovulation and stabilize hormonal swings, thereby offering relief from PMS symptoms. Yaz, a new type of birth control pill, has been shown to be effective in reducing the physical and emotional symptoms of PMDD. It's the first oral contraceptive to be approved for this use.
• Antidepressants. Selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac, Sarafem), paroxetine (Paxil) and sertraline (Zoloft), have been successful in reducing symptoms such as fatigue, food cravings and sleep problems. These drugs are generally taken daily. But for some women with PMS, use of antidepressants may be limited to the two weeks before menstruation begins.
• Medroxyprogesterone acetate (Depo-Provera). For severe PMS or PMDD, this injection can be used to temporarily stop ovulation. However, Depo-Provera may cause an increase in some signs and symptoms of PMS, such as increased appetite, weight gain, headache and depressed mood.

Treatment for PMDD is similar to that of premenstrual syndrome, but may be more intense.