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Premenstrual Syndrome

by JoAnn V. Pinkerton, MD

Premenstrual syndrome (PMS) is a group of physical and psychologic symptoms that start several days before and usually end a few hours after a menstrual period begins.

  • PMS includes any combination of the following: becoming irritable, anxious, moody, or depressed or having headaches or sore, swollen breasts.

  • Doctors base the diagnosis on symptoms, which are usually tracked in a monthly calendar.

  • Consuming less sugar, salt, and caffeine and exercising may help relieve symptoms, as does taking certain supplements, pain relievers, birth control pills (sometimes), or antidepressants.

Because so many symptoms, such as a bad mood, irritability, bloating, and breast tenderness, have been ascribed to PMS, defining and identifying PMS can be difficult. About 20 to 50% of women of childbearing age have PMS. About 5% have a severe form of PMS called premenstrual dysphoric disorder.

PMS may occur partly because estrogen and progesterone levels fluctuate during the menstrual cycle. Some women are more sensitive to these fluctuations. Some women may have a genetic make-up that makes them more susceptible to PMS. Also, serotonin levels tend to be lower in women with PMS. Serotonin is a substance that helps nerve cells communicate (a neurotransmitter) and is thought to help regulate mood.

The fluctuations in estrogen and progesterone may affect other hormones, such as aldosterone, which helps regulate salt and water balance. Excess aldosterone can cause fluid retention and bloating.

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