Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) What is premenstrual syndrome (PMS)? Premenstrual syndrome is the physical and emotional symptoms that some women have before their menstrual period begins. Premenstrual syndrome is commonly called PMS. At least 75% of all menstruating women have some symptoms of PMS. Symptoms vary from woman to woman and may be mild to severe. What is premenstrual dysphoric disorder (PMDD)? Premenstrual dysphoric disorder (PMDD) is a very severe form of premenstrual syndrome. PMDD includes severe physical, emotional, and quality-of-life problems. About 5% to 10% of women have PMDD before each menstrual period begins. Severe symptoms, such as anger that is out of control, seriously disrupt daily life. How do they occur? PMS and PMDD are related to hormonal changes during the menstrual cycle. A single cause has not been found. Researchers are checking the effects of a woman's sex hormones on brain chemistry and other aspects of body metabolism. They are looking at levels of testosterone in women that may lead to the more severe symptoms of PMDD. Some scientists think PMDD may be caused by an imbalance of a chemical in the body called serotonin. What are the symptoms? PMS and PMDD symptoms usually occur during the second half of your menstrual cycle. Often the symptoms start a few days before your menstrual period, but they may start as much as 2 weeks before your period. Physical symptoms are the same for PMS and PMDD. With PMDD, however, the emotional symptoms are much more serious. You may feel very depressed and hopeless. Physical symptoms may include: bloated stomach swollen feet or hands tender, enlarged breasts crampy pain in the lower abdomen weight gain headache nausea, vomiting, diarrhea, constipation appetite changes joint or muscle pain acne. Emotional symptoms may include: irritability anger depression anxiety tension fatigue, lack of energy difficulty concentrating confusion crying spells feeling overwhelmed or out of control social withdrawal (not wanting to be around other people) lack of or decrease in sex drive. Many women who have PMS also experience difficulties in their relationships with families and friends. With PMDD, these difficulties are severe. How is it diagnosed? You may have a physical and pelvic exam and some lab tests to check for possible causes of your symptoms. However, PMS or PMDD cannot be diagnosed from a physical exam or any one lab test. Your health care provider may ask you to keep a diary of your activities, mood, and physical symptoms every day for 2 months. A diary is very important to find out if you have PMDD. Symptoms that always appear 1 to 2 weeks before your periods may be caused by PMS or PMDD. For you to be diagnosed with PMDD, your monthly symptoms must significantly interfere with work, school, or relationships. Diagnosis can be difficult and may take several months of careful observation. How is it treated? No one therapy works for all women. The treatments described below may help improve symptoms. Also, aerobic exercise, rest, stress reduction, and less salt, caffeine, and refined sugar in your diet may help. Psychotherapy Counseling may help you deal with your emotional or relationship difficulties. Cognitive behavioral therapy may also help with PMDD. Medicine Anti-inflammatory drugs, such as ibuprofen and naproxen, can help most premenstrual cramping and headaches. If your cramps are severe, you may need to start taking the anti-inflammatory drugs 1 to 2 days before you expect your cramps to begin. This can prevent the production of cramp-causing chemicals by your body. These drugs can also help prevent the nausea, vomiting, and diarrhea caused by the same chemicals. You may need prescription medicine for PMS headaches. Your health care provider may prescribe a mild diuretic (water pill) for bloating and swelling. If you have severe breast symptoms, your provider may prescribe medicine that might help. Prescription medicine is available for the treatment of PMDD. Research has shown that fluoxetine (Prozac, Sarafem), sertraline (Zoloft), or paroxetine HCl (Paxil) can help. These drugs reduce aggression and irritability. Medicines for this disorder help 60% to 70% of women with PMDD. Hormone therapy, such as natural progesterone or birth control pills, may be prescribed. Progesterone may help bloating and breast tenderness. It may also help psychological symptoms. Birth control pills may help some physical symptoms, but they do not appear to help psychological symptoms. Leuprolide (Lupron), which suppresses the sex hormones, is another possible hormone treatment, but taking it for a long time can cause bone loss. Natural Remedies and Alternative Treatments To reduce breast tenderness and swelling, do not eat chocolate or drink beverages containing caffeine. You may need to cut these foods from your diet completely or you may need to avoid them only during the last half of your menstrual cycle. Limit the salt in your diet during the last half of your menstrual cycle to reduce problems of bloating and swelling. Nutritional supplements are often recommended for mild to moderate PMS symptoms: calcium magnesium vitamin B6 vitamin E tryptophan. Acupuncture may provide relief for headaches, fatigue, depression, backache, and other symptoms of PMS and PMDD. How long will the effects last? The symptoms of PMS usually start a few days before your menstrual period and continue until your period begins. You may keep having symptoms during your period. The symptoms of PMS change as you mature, go through childbearing age, and enter menopause. During menopause PMS symptoms may go away, but you may have other symptoms caused by menopause. How can I take care of myself? Know how and when PMS affects you. You can then change your diet, exercise, and schedule in ways that help PMS to pass as smoothly as possible. If you have PMDD, make sure you get medical and psychological treatment. Join a support group for women dealing with the challenges of PMS or PMDD. Call your health care provider if you have severe symptoms or notice that your symptoms vary from one month to the next. There may be a more serious cause of your symptoms that needs treatment. What can I do to help prevent PMS and PMDD? There is no reliable way to prevent PMS and PMDD because the cause of these disorders has not been identified. You may be able to lessen the symptoms if you eat a healthy diet, maintain a normal weight, exercise regularly, and take anti-inflammatory drugs when necessary. If these measures fail, ask your health care provider about prescription treatments.