Premenstrual syndrome presents itself with a combination of physical and emotional symptoms. These include:

• Headache
• Undue fatigue
• Muscle ache and joint pain
• Bloating
• Abdominal distention
• Constipation or diarrhea
• Muscle cramps
• Breast tenderness [6]
• Gain in weight
• Sleep problems
• Mood swings
• Depression [7]
• Crying spells
• Poor concentration
• Anxiety [8]
• Tension

Women with PMS do not experience all the above symptoms at the same time.

• Fatigue

  Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems. Depression. [mayoclinic.org]

  Vitamin B6 helps to regulate several hormones and can reduce fatigue. Vitamin B12, pantothenic acid (B5) und folic acid (B9) also contribute to a normal functioning of the nervous system. [amitamin.com]

  Vitamin E may reduce breast tenderness, nervous tension, fatigue, and insomnia. Vitamin B 6 may decrease fluid retention, fatigue, irritability, and mood swings. Vitamin B 5 supports the adrenal glands and may help reduce fatigue. [medical-dictionary.thefreedictionary.com]

  Depression, chronic fatigue, and premenstrual syndrome often coexist in women seeking treatment for premenstrual distress. [ncbi.nlm.nih.gov]

• Weight Gain

  Magnesium: Research has found that supplementation with magnesium significantly reduced weight gain, bloating, and breast tenderness in women with PMS. [lifeextension.com]

  A transient increase in water retention seems to account for edema, weight gain, bloating, and breast changes. [medical-dictionary.thefreedictionary.com]

  Definition (CSP) occurs in some women prior to menstruation; salt and water retention cause weight gain and bloating; individuals may experience mood changes. [fpnotebook.com]

• Anorexia

  […] cognitive") symptoms: decreased concentration, indecision Pain: headache (e.g., menstrual migraine), breast tenderness, joint and muscle pain Nervous system symptoms: insomnia (sleeplessness), hypersomnia (sleeping for abnormally long periods of time), anorexia [healthcommunities.com]

  […] during the luteal phase of the menstrual cycle, and negative impact of symptoms on function and lifestyle. 4 View/Print Table TABLE 4 Differential Diagnosis of Premenstrual Syndrome Affective disorder (e.g., depression, anxiety, dysthymia, panic) Anemia Anorexia [aafp.org]

  A lack of estrogen, common in menopausal women and those unable to produce adequate estrogen, such as women with anorexia or who exercise excessively, impairs calcium absorption. [todaysdietitian.com]

  […] the lack of studies directly comparing treatment modalities, and the high response rate to placebo (25 to 50 percent). 2,3 TABLE 4 Differential Diagnosis of Premenstrual Syndrome Affective disorder (e.g., depression, anxiety, dysthymia, panic) Anemia Anorexia [web.archive.org]

• Ankle Swelling

  Abdominal swelling or bloating. Weight gain. Swollen ankles. Headaches and possibly migraine. None of these symptoms is exclusive to PMS. [netdoctor.co.uk]

• Leg Swelling

  The lesions coincided with a premenstrual syndrome, characterized by fluid retention-related symptoms, such as leg swelling, breast tenderness, bloatedness with abdominal girth variation and weight gain. [ncbi.nlm.nih.gov]

• Nausea

  Trichomonas vaginalis was significantly correlated with headache and Gardnerella vaginalis with nausea. [ncbi.nlm.nih.gov]

  […] concentration, confusion, forgetfulness, restlessness, loneliness, decreased self-esteem, tension Physical symptoms : headaches, breast tenderness and swelling, back pain, abdominal pain and bloating, weight gain, swelling of extremities, water retention, nausea [americanpregnancy.org]

• Abdominal Bloating

  The most common physical and emotional signs and symptoms associated with premenstrual syndrome include: Weight gain from fluid retention Abdominal bloating Breast tenderness Tension or anxiety Depressed mood Crying spells Mood swings and irritability [web.archive.org]

  The most frequent symptoms were abdominal bloating (89.5%), irritability (88.3%) and breast tenderness (82.6%). Quality of life scores ranged from 17.00 to 97.00 and were lowest in the severe PMS group. [ncbi.nlm.nih.gov]

  bloating Breast tenderness Acne flare-ups Constipation or diarrhea Alcohol intolerance For some, the physical pain and emotional stress are severe enough to affect their daily lives. [mayoclinic.org]

  Symptoms: Mood swings Mild-to-severe personality change Acne Decreased energy Tension Altered sex drive Breast pain or tenderness Backache Swollen fingers and ankles Headaches Abdominal bloating Depression Sugar craving Cramps Irritability Weight gain [himalayawellness.com]

• Abdominal Pain

  The disorders can manifest with a wide variety of symptoms, including depression, mood lability, abdominal pain, breast tenderness, headache, and fatigue. [ncbi.nlm.nih.gov]

  Definition of premenstrual syndrome : a varying group of symptoms manifested by some women prior to menstruation that may include emotional instability, irritability, insomnia, fatigue, anxiety, depression, headache, edema, and abdominal pain — called [merriam-webster.com]

  especially backache Headaches Weight gain Appetite changes Acne or other skin rashes Constipation or diarrhoea Muscle or joint stiffness Exacerbation of epilepsy, migraine, asthma, rhinitis or urticaria Abdominal pain/cramps Treatment guidelines full [guidelines.co.uk]

  Fatigue Skin problems Gastrointestinal symptoms Abdominal pain The cause of premenstrual syndrome is unclear, but seems to be related to fluctuations in estrogen and progesterone levels in the body. [chop.edu]

• Abdominal Cramps

  The most frequent symptoms are irritability, depression, fatigue, water retention, weight gain, breast tenderness, headaches, abdominal cramps and mood swings. [drtorihudson.com]

  Affected women tend of experience the following symptoms most frequently: irritability tension loss of appetite and abdominal cramps swelling or tenderness in the breasts loss of energy headaches, back pain mood swings, dysphoria (unhappiness), depression [amitamin.com]

  In a new study from the University of Massachusetts Amherst and Harvard School of Public Health, researchers found that the headaches, abdominal cramping, fatigue and other symptoms associated with PMS may be signs of impending hypertension. [techtimes.com]

  The symptoms include both physical symptoms, such as breast tenderness, back pain, abdominal cramps, headache, and changes in appetite, as well as psychological symptoms of anxiety, depression, and unrest. [medical-dictionary.thefreedictionary.com]

  cramps Bloating Constipation Nausea Vomiting Diarrhea Pelvic heaviness or pressure Backache Skin problems Acne Neurodermatitis (skin inflammation with itching) Aggravation of other skin disorders, including cold sores Neurologic and vascular symptoms [stanfordchildrens.org]

• Abdominal Fullness

  It features irritability, depression, fatigue, tension, headache, breast tenderness, a sense of abdominal fullness and pain, fluid retention and backache. Various treatments may have to be tried before relief is obtained. [medical-dictionary.thefreedictionary.com]

• Back Pain

  Affected women tend of experience the following symptoms most frequently: irritability tension loss of appetite and abdominal cramps swelling or tenderness in the breasts loss of energy headaches, back pain mood swings, dysphoria (unhappiness), depression [amitamin.com]

  pain, joint and muscle pain The following disorders aren't PMS. [msdmanuals.com]

  On the other hand, taking calcium pills may reduce symptoms of water retention, cramps, and back pain. [familydoctor.org]

• Muscle Spasm

  Here are 15 very effective herbs for menstrual pain. 1) CRAMP BARK & BLACK HAW These are probably the most effective herbs for reducing uterine spasm and cramping. These sister herbs bring relief of pain and muscle spasm in the uterus. [preventdisease.com]

  Motherwort Useful for stimulating uterine tone, motherwort may also help to reduce uterine muscle spasms and cramping. Motherwort is also used to relieve stress and heart symptoms due to anxiety. [articles.mercola.com]

  spasms Other Decreased coordination Painful menstruation Diminished libido (sex drive) Appetite changes Food cravings Hot flashes The symptoms of PMS may resemble other conditions or medical problems. [stanfordchildrens.org]

  […] with itching) aggravation of other skin disorders, including cold sores neurologic and vascular symptoms headache vertigo syncope (fainting) numbness, prickling, tingling, or heightened sensitivity of arms and/or legs easy bruising heart palpitations muscle [health.am]

• Muscle Cramp

  These include: Headache Undue fatigue Muscle ache and joint pain Bloating Abdominal distention Constipation or diarrhea Muscle cramps Breast tenderness Gain in weight Sleep problems Mood swings Depression Crying spells Poor concentration Anxiety Tension [symptoma.com]

• Mastodynia

  Water retention in the breast increases during this second, luteal phase, which is one of the main causes for the painful swelling of tissue inside the breast (mastodynia). [amitamin.com]

• Mood Swings

  PMDD signs and symptoms include depression, mood swings, anger, anxiety, feeling overwhelmed, difficulty concentrating, irritability and tension. [mayoclinic.org]

  Vitamin B 6 may decrease fluid retention, fatigue, irritability, and mood swings. Vitamin B 5 supports the adrenal glands and may help reduce fatigue. [medical-dictionary.thefreedictionary.com]

  Low production of this neurotransmitter is thought to give rise to depression, sleep problems, food cravings and mood swings before the onset of menstrual cycle. [symptoma.com]

  Symptoms of mood swings, irritability, and anxiety occur in many women during the premenstrual phase of the menstrual cycle. Several promising treatment options now exist for women whose symptoms are severe and interfere with daily functioning. [ncbi.nlm.nih.gov]

• Loss of Libido

  ESTROGEN DOMINANCE AND PMS Progesterone deficiency (estrogen dominance) is much more likely since many of the symptoms correlate with estrogen dominance symptoms, most notably water retention, breast swelling, headaches, mood swings, loss of libido, and [johnleemd.com]

  The risk of perimenopausal and postnatal depression as well as anxiety disorders, appears to be higher amongst women with PMD. [ 3 ] Psychosexual problems, loss of libido and dyspareunia may be reported but usually have to be specifically asked about. [patient.info]

  It is suggested that avoidance of continuous use may reduce the risk of side effects of SSRIs, which can include anxiety, dizziness, insomnia, sedation, gastrointestinal disturbance, headache, loss of libido and anorgasmia (inability to achieve orgasm [doi.org]

• Aggressive Behavior

  behavior, with outbursts of anger toward self or others Loss of sex drive (may increase in some women) Mood swings Poor judgment Poor self-image, feelings of guilt, or increased fears Sleep problems (sleeping too much or too little) There are no specific [nlm.nih.gov]

  behavior, with outbursts of anger toward self or others Loss of sex drive (may increase in some women) Mood swings Poor judgment Poor self-image, feelings of guilt, or increased fears Sleep problems (sleeping too much or too little) Exams and Tests There [mountsinai.org]

  Key Words premenstrual syndrome aggressive behavior criminal behavior aggression violence This is a preview of subscription content, log in to check access. Preview Unable to display preview. Download preview PDF. [link.springer.com]

• Emotional Outbursts

  Associated with verapamil therapy was a decreased severity in many symptoms of PMS, including agitation, depression, emotional outbursts, and irritability. A possible mechanism is discussed. [ncbi.nlm.nih.gov]

  outbursts See your doctor if physical pain, mood swings, and other symptoms start to affect your daily life, or if your symptoms don’t go away. [healthline.com]

• Behavior Disorder

  This protocol is designed to accompany Clinical Protocol # 81-M-0126, The Phenomenology and Biophysiology of Menstrually-Related Mood and Behavioral Disorders. [clinicaltrials.gov]

  This book, in 85,000 words with 1,250 references, covers the neuroscience of the menstrual cycle, the medicine of menstruation, menstrual mood and behavioral disorders, and the case lore of menstrual psychosis, followed by an analysis of 80 cases with [doi.org]

• Irritability

  Vitamin B 6 may decrease fluid retention, fatigue, irritability, and mood swings. Vitamin B 5 supports the adrenal glands and may help reduce fatigue. [medical-dictionary.thefreedictionary.com]

  Vitamin B6: Vitamin B6 has been shown to improve symptoms of bloating, headache, breast pain, depression, and irritability. [lifeextension.com]

  Tranquilizers (eg, a benzodiazepine) may be used for irritability, nervousness, and lack of control, especially if patients cannot alter their stressful environments. [health.am]

  PMDD signs and symptoms include depression, mood swings, anger, anxiety, feeling overwhelmed, difficulty concentrating, irritability and tension. [mayoclinic.org]

  PMDD is a severe form of premenstrual syndrome with symptoms including severe depression, feelings of hopelessness, anger, anxiety, low self-esteem, difficulty concentrating, irritability and tension. [web.archive.org]

• Headache

  The physical symptoms include: bloating, headaches, food cravings, abdominal cramps, headaches, tension, and breast tenderness. Emotional aspects include mood swings, irritability, and depression. [medical-dictionary.thefreedictionary.com]

  Vitamin B6: Vitamin B6 has been shown to improve symptoms of bloating, headache, breast pain, depression, and irritability. [lifeextension.com]

  […] overeating Psychological symptoms : irritability, anger, depressed mood, crying and sadness, anxiety, tension, mood swings, lack of concentration, confusion, forgetfulness, restlessness, loneliness, decreased self-esteem, tension Physical symptoms : headaches [americanpregnancy.org]

  Over-the-counter pain relievers such as ibuprofen, aspirin or naproxen may help ease cramps, headaches, backaches and breast tenderness. Exercising, getting enough sleep, and avoiding salt, caffeine, and alcohol can also help. [fpnotebook.com]

There are no particular diagnostic tools for diagnosing PMS. Women need to consult their gynecologist when they begin experiencing unusual symptoms prior to menstrual cycle. It is also advised that women maintain a record diary wherein they would keep track of all the symptoms experienced during the week before the menstrual cycle begins. It is also necessary that women also make note of the date of initiation of period and the date when it ends.

Medications form the preliminary and most important part of treatment regime [9]. The following is the list of medications that are prescribed for treating PMS:

• Antidepressants belonging to the class of serotonin reuptake inhibitors have a positive impact on PMS symptoms. These drugs help to deal with problems of food cravings, mood swings, depression, sleep problems and fatigue.
• Non–steroidal anti-inflammatory drugs such as Advil, Aleve and Motrin are taken on the day of menstrual cycle. These drugs help relieve pain and discomfort.
• Diuretics can help reduce the fluid retention by shedding off the excess fluid through the kidneys.
• Oral contraceptives are prescribed which help stabilize the hormonal shifts and relieve the PMS symptoms.

In addition to medications, women are also advised to exercise regularly and stay physically active. Diet rich in vitamins and minerals and low in salt is also advised to avoid water retention during PMS.

Symptoms of PMS tend to get better with appropriate treatment. Medications and changes in life style have shown to play major role in improvement of PMS symptoms. However, a small percentage of women continue to suffer from severe symptoms until menopause.

Complications

The following are the complications associated with PMS:

• Women with PMS can suffer from major depressive disorders.
• Research has pointed towards the fact that women with PMS significantly indulge in alcohol and other substance abuse as compared to their counterparts.
• PMS also greatly increases the risk of other medical illnesses such as asthma and migraines. Certain other conditions can also get aggravated during PMS; these include irritable bowel syndrome, inflammatory bowel disease, seizures, epilepsy and multiple sclerosis.

The exact cause of premenstrual syndrome is unknown. However, several factors that are known to play a significant role in development of PMS have been listed below:

• Hormonal changes contribute significantly to PMS. The symptoms associated with hormonal fluctuations tend to go away during pregnancy and menopause [2].
• Changes in the levels of serotonin in the brain are known to trigger several symptoms of PMS. Low production of this neurotransmitter is thought to give rise to depression, sleep problems, food cravings and mood swings before the onset of menstrual cycle.
• Stress is one of the significant factors that can aggravate symptoms of premenstrual syndrome.
• Faulty eating habits are also identified as one of the potential factors that can give rise to PMS. A diet low in vitamins and minerals, high in sodium and caffeine can pave way for development of PMS in many women.
• Current researches has unearthed evidence that alterations in the endorphin release, gamma aminobutyric sytem, and production of prolactin may influence the occurrence of PMS [3].

PMS is a very common condition and it has been estimated that 3 out of every 4 women are affected with this condition. In the United States, about 90% of women suffer from PMS at least once in their lifetime. Women who smokes has twice the propensity to develop severe PMS than non-smokers [4].

Changes in the hormonal levels during the ovulation period are known to trigger premenstrual syndrome. A significant shift in the hormonal levels can cause drastic mood changes and can trigger symptoms of PMS. A diet that is low in magnesium and calcium can also trigger PMS. When nutritional supplements were given to menstruating women suffering from PMS, a significant improvement in the symptoms was noticed. Research has also found a strong link between deficiency of serotonin – brain chemical and PMS. PMS become totally non-existent beyond menopausal [5].

An active lifestyle and a healthy diet can go a long way in preventing PMS. Staying physically active and exercising regularly can help keep several symptoms of PMS at bay [10]. A proper diet combined with regular exercise helps relieve stress, improves the energy levels and has a positive impact on the mood of the individual.

Premenstrual syndrome (PMS) refers to group of symptoms experienced at least a week before the menstrual period. Women in their late 20s and early 30s tend to experience these symptoms than their younger counterparts.

Emotional and physical symptoms are experienced during this period. However, the degree of intensity of these symptoms varies from one cycle to another. The symptoms begin approximately ten days before the commencement of the cycle and fade off either before the day or on the first day of the menstrual cycle. In some cases, women tend to experience severe symptoms prior to their menstrual cycle; such condition is referred to as premenstrual dysphoric disorder (PMDD) [1].

Definition

Premenstrual syndrome (PMS) is defined as group of symptoms that begins a week or two before the onset of menstrual cycle. The symptoms generally fade away with the commencement of menstruation. It is a common problem and is known to affect about 75% of women worldwide.

Cause

The exact cause that triggers PMS is not known. However, hormonal changes, poor dietary habits and lifestyle factors are known to play foul.

Symptoms

Women with PMS experience both emotional as well as physical symptoms which include breast tenderness, bloating, constipation or diarrhea, weight gain due to fluid retention, mood swings, depression, crying spells, fatigue, sleep problems, headache, joint aches, acne break outs and food cravings.

Diagnosis

There are no specialized diagnostic procedures to detect PMS. However, women are advised to visit their gynecologist once they experience some unusual symptoms prior to their regular periods.

Treatment

Medications form the basis of treatment regime. Antidepressants, NSAIDs, oral contraceptives and diuretics are prescribed to relieve the symptoms caused due to PMS. Adopting good dietary habits and following an active lifestyle also has a positive impact on PMS.

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