Premenstrual syndrome and premenstrual dysphoric disorder

Premenstrual syndrome (PMS) is a group of physical, emotional and behavioral symptoms that may appear before menstruation each month.

Premenstrual dysphoric disorder (PMDD) is a psychiatric condition with symptoms similar to PMS. However, the symptoms are much more severe. Often, symptoms significantly interfere with relationships and daily activities at work, home or school.


Causes/associated factors
Most women experience some symptoms of premenstrual syndrome. Fewer women are affected by PMDD, probably less than 10 percent of all women.
The exact cause of PMS and PMDD is unknown, but factors that may be involved include:

fluctuating levels of the hormones estrogen or progesterone just before your period
low levels of serotonin (a hormone that helps regulate mood)
certain vitamin and mineral deficiencies, such as vitamin B6, calcium or magnesium
trouble with certain metabolic processes
Both syndromes are most common for women in their late 20s to age 40. The symptoms end with menopause.


Signs/symptoms
For some women, PMS is mild or barely noticeable. For others, symptoms are more numerous and bothersome. PMS and PMDD symptoms typically appear about one to two weeks before your period and disappear once menstruation begins. Sometimes they last a few days into your period.
More than 100 symptoms have been attributed to PMS. The most common include:

abdominal cramping
constipation or diarrhea
nausea or vomiting
swelling of the hands and feet
acne
thirst
dizziness
clumsiness
altered sexual drive
In addition to the symptoms listed above, PMS shares another set of symptoms with PMDD. For women who have PMDD, the following symptoms are typically constant and severe. For women who have PMS, the following symptoms are less severe.

depression
anxiety
severe mood swings and crying spells
anger or irritability
decreased interest in usual activities and people
difficulty concentrating
fatigue
changes in appetite, food cravings or episodes of bingeing
sleep disturbances
feeling overwhelmed
physical symptoms such as breast tendernes or swelling, headaches, bloating, muscle aches, joint pain and weight gain

Diagnosis
There is no specific diagnostic test for PMS. Your doctor will do a physical exam and ask questions about your symptoms and medical history. To help make a diagnosis, you may be asked to keep a journal of your symptoms along with a record of your menstrual cycle for two or three months. Charting your basal body temperature (your body temperature just after awakening and before arising or any other activities) each day may help in making the diagnosis. If at least one premenstrual symptom occurs each month, you may be diagnosed with PMS. If the symptoms occur at any time during the month other than the week or two before through a day or two into your period, PMS is usually ruled out.
The diagnosis of PMDD is more specific. As with PMS, the symptoms must occur during the premenstrual time frame. You must also have at least five of the specific symptoms listed above, and they must be severe enough to interfere with your relationships and typical activities. The symptoms must not be a worsening of other mental health conditions, such as depression or anxiety. PMDD may coexist with these disorders, however.


Treatment
There is no cure for PMS or PMDD. Instead, the goal of treatment is to relieve or possibly eliminate your particular symptoms and improve your ability to function normally.
An important first step is to consider lifestyle modifications. You may find it helpful to exercise regularly, rest, sleep at least eight hours a night and reduce your stress level as much as possible. Avoid smoking. Try limiting your intake of salt, refined sugar, alcohol and caffeine. (Remember that caffeine may be found in coffee, tea, sodas and chocolate.) Eating a diet high in complex carbohydrates, including whole grains and fresh fruits and vegetables, may have a positive effect.

Recent studies have been done to evaluate the effectiveness of certain vitamins and minerals on PMS and PMDD symptoms, including vitamin E, vitamin B6, calcium and magnesium. Although formal recommendations have not been made, they may be helpful for some women. Ask your doctor for details.

Your doctor may recommend a mild diuretic to ease water retention or a nonsteroidal anti-inflammatory medication, such as ibuprofen or naproxen, to relieve cramping, muscle aches and headaches.

If lifestyle modifications and over-the-counter medication aren't effective or you experience more bothersome symptoms, your doctor may prescribe other medications, such as an antidepressant. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) or sertraline (Zoloft) have been approved by the U.S. Food and Drug Administration (FDA) to be used in the treatment of PMDD. Other SSRIs may also be effective. Studies indicate these medications increase levels of serotonin and improve symptoms for some women.

Hormonal therapies may be recommended if antidepressants are not effective. Hormonal therapy may include the use of birth control pills or other hormonal medications. Supportive counseling may also be recommended to treat PMDD.


Complications
If you experience severe symptoms or your symptoms change from month to month, consult your doctor for an evaluation. Rarely, more serious conditions unrelated to PMS or PMDD may be present.
By definition, PMDD interferes with relationships and the activities of daily life. If left untreated, this social interruption may cause additional problems such as isolation or feelings of hopelessness. Timely treatment of PMDD can help prevent these types of complications.


Prevention
In most cases, PMS and PMDD can't be prevented. You may be able to limit the symptoms, however. Eat a healthful diet, maintain your ideal body weight, exercise regularly, and try the treatment recommendations described above.