Premenstrual Syndrome (PMS)

Symptoms

Premenstrual symptoms are a natural part of the menstrual cycle, affecting over 85% of women at some time during their lives.⁴ If your body doesn't react strongly to its monthly hormonal changes, you probably have mild premenstrual symptoms or none at all. However, if you have one or more mild to moderate premenstrual symptoms that disrupt your work, relationships with others, or sense of well-being, you are said to have premenstrual syndrome (PMS).

PMS symptoms vary greatly from woman to woman and cycle to cycle, and can range from mild to severe. Some women note that their symptoms are worse during times of increased emotional or physical stress. Of the more than 150 symptoms that have been linked to PMS, the most common are listed below.

Physical symptoms include:

• Breast swelling and tenderness.
• Bloating, water retention, weight gain.
• Changes in bowel habits.
• Acne.
• Nipple discharge when nipples or breasts are pressed. (Any leakage that spontaneously happens when you aren't pressing on the nipple should be checked by a health professional.)
• Food cravings, especially for sweet or salty foods.
• Sleep pattern changes.
• Fatigue, lack of energy.
• Decreased sexual desire.
• Pain. Common complaints include headaches or migraines, breast tenderness, aching muscles and joints, or cramps and low back pain prior to menstrual bleeding.

Behavioral symptoms include:

• Aggression.
• Withdrawal from family and friends.

Emotional and cognitivesymptoms include:

• Depression, sadness, hopelessness.
• Anger, irritability.
• Anxiety.
• Mood swings.
• Decreased alertness, inability to concentrate.

By definition, premenstrual symptoms only occur during the luteal phase, between ovulation and the start of menstrual bleeding, or soon after. Premenstrual symptoms can occur during the entire luteal phase or can appear briefly during ovulation, in the days leading up to menstrual bleeding, or both. You may notice that the severity and pattern of your PMS symptoms varies from month to month. You may also stop or start having PMS symptoms for no clear reason.

Severe symptoms

If you have severe premenstrual mood swings, depression, irritability, or anxiety (with or without physical symptoms), you are said to have premenstrual dysphoric disorder (PMDD). Symptoms generally subside within the first 3 days of menstrual bleeding. This severe type of PMS affects up to 8% of women.⁵ Women with PMDD symptoms tend to report that they:

• Have negative behavior and feelings of hopelessness.
• Feel guilt and shame.
• Feel they have lost control over their lives.
• Believe they are mentally ill and fear the stigma of mental illness.
• Have poor job performance or missed workdays during the premenstrual period.
• Feel distanced from family and friends.

Premenstrual worsening of other conditions

You may notice that symptoms of other medical conditions get worse between ovulation and the first day of menstrual bleeding—this is called menstrual magnification. The conditions most affected are:⁴

• Mental health problems, such as depression, anxiety disorders, bipolar disorder, schizophrenia, and eating disorders.
• Endometriosis.
• Migraine headaches.
• Seizure disorders.
• Irritable bowel syndrome (IBS).
• Asthma.
• Chronic fatigue syndrome.
• Allergies.
• Anemia.⁶
• Thyroid disease.⁶

Are my symptoms truly premenstrual, starting after I ovulate?

What seems like PMS can sometimes be caused by another condition. It's important to know, because your treatment options will be different if your symptoms aren't actually linked to premenstrual hormone changes. The best way to learn whether your symptoms are premenstrual is to know when you ovulate (the day you ovulate is the start of your premenstrual phase). Keep track of ovulation days, a daily record of your symptoms, and menstrual bleeding days in a menstrual diary(What is a PDF document?).

You can most accurately pinpoint your ovulation day by monitoring your cervical mucus, your basal body temperature (BBT), and your luteinizing hormone (LH) changes with an ovulation test.⁷ Traditionally, ovulation was thought to happen 14 days before the next menstrual period, or on day 15 of a 28-day cycle. However, recent research suggests that ovulation dates vary widely from woman to woman and from month to month.⁸

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Author:	Kathe Gallagher, MSW	Last Updated: July 7, 2006
Medical Review:	Renée M. Crichlow, MD - Family Medicine Kathleen Romito, MD - Family Medicine Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
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