Premenstrual Syndrome and Premenstrual Dysphoric Disorder

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Rogerio A. Lobo, MD
JoAnn Pinkerton, MD

Additional Resources
Mayo Clinic

Most women of reproductive age are well aware of common premenstrual symptoms. Premenstrual syndrome, also known as PMS, includes both emotional and physical signs that a woman's menstrual period is starting. Symptoms typically go away shortly after the period begins.

Premenstrual dysphoric disorder, also known as PMDD, is a more severe form of PMS, affecting about 3–6% of women. PMDD can interfere with daily life and make it hard for a woman to maintain relationships. Women who have had major depression are more likely than others to have PMDD.

What Are the Signs and Symptoms of PMS and PMDD?

PMDD and PMS symptoms are the same, but the severity is different. Physical signs can include fatigue and problems with sleep, such as sleeping too much or too little. Women may also experience joint and muscle pain, headaches and breast tenderness. Temporary weight gain and bloating, cravings, and other changes in appetite and constipation or diarrhea can also affect women with premenstrual syndrome.

Premenstrual symptoms also include emotional problems, such as tension, anxiety, depression, anger, irritability and feelings of hopelessness. Women may experience crying spells and mood swings, have trouble concentrating or face a desire to withdraw from family and friends. Women with PMDD may feel depressed, extremely anxious, have high levels of irritability, and feel overwhelmed or out of control. Suicidal thoughts may occur, and they may completely withdraw from others and lose interest in normal activities.

What Causes PMS and PMDD?

Doctors are still searching for the exact cause of premenstrual syndrome or PMDD. Changes in hormone levels are likely one cause, as well as changes in neurotransmitters in the brain. Some women have a genetic risk factor for PMDD. Undiagnosed depression or anxiety can also lead to problems.

What Is the Treatment for PMS and PMDD?

Lifestyle changes and medication can both be used to treat these conditions, and often a combination of these is the best option. Women may be able to lessen their symptoms by eating small, frequent meals that are low in salt but high in fruits, vegetables, and whole grains. Lean proteins can also help. Adding about 1,200 milligrams of calcium as well as vitamin D, vitamin E, vitamin B6, and magnesium supplements is also beneficial.

Although many women with PMS do not feel like exercising, exercise it can lessen the symptoms of the syndrome. Aim for a healthy average of 30 minutes a day, five days a week. Stress reduction techniques, healthy sleep habits, and decreased caffeine use can also help.

Medications for PMS symptoms include diuretics, or water pills, that relieve bloating. Painkillers and anti-inflammatory medications can lower pain and inflammation levels. Birth control pills help regulate hormone levels and may make PMS less intense. Other medication options include anti-anxiety drugs, antidepressants and gonadotropin-releasing hormone agonists.

PMS is part of life for most women. While the symptoms can be uncomfortable, they should not be life-altering. If you are experiencing PMS symptoms that are affecting your daily life, talk to your doctor to discuss the possibility that you need further treatment of PMDD.

Questions to ask your doctor

  • What is my diagnosis?
  • What are my treatment options?
  • What are the advantages and disadvantages of each of my treatment options?
  • Should I see an endocrinologist for my condition?