Premenstrual Syndrome

If you have symptoms of PMS that do not go away within 3-4 days of the start of your period, call your doctor. You may have a different medical problem.

When the typical symptoms of PMS become so severe that your lifestyle is drastically altered, talk with your health care provider.

• Your doctor will evaluate your symptoms for signs of premenstrual dysphonic disorder (PMDD), a mental health concern, which should be diagnosed and treated.
• Serious signs may also signify other mental or medical problems. Psychiatric diagnoses such as chronic depression, anxiety disorders, and personality disorders may overlap with the diagnosis of PMDD. Medical considerations include hormone imbalances, thyroid disorders, electrolyte problems, and low levels of red blood cells. Your doctor will want to rule out these more serious medical problems.
• If you have such serious mood changes or behavior changes that you feel you may hurt yourself or another person, seek medical care immediately at a hospital’s emergency department.

Self-Care at Home

Self care reduces many premenstrual symptoms.

Dietary strategies may help.

• To lessen bloating and water retention, avoid foods high in salt (sodium), especially in the week before your period.
• Because diet may play a role in symptoms associated with low blood sugar, avoid candy, soda, and other sugary foods, especially in the week before your period.
• An adequate vitamin and mineral intake may also help with PMS symptoms.

• Vitamin E: Studies do not agree about how much vitamin E may be helpful, but 300-400 IU per day is a safe dose that may be of benefit.
• Calcium: Some women get relief being careful to take at least 1,200 mg of calcium per day, through a combination of normal eating and taking supplements.
• Magnesium: Most studies that have evaluated magnesium have failed to show overall benefit. One study of magnesium (200 mg/day) with 50 mg of vitamin B6 showed a significant reduction in anxiety symptoms, compared to magnesium alone. Food sources of magnesium include nuts, legumes, whole grains, dark green vegetables, seafood (oysters), and meats.

Regular aerobic exercise and relaxation techniques can help to relieve many of the mood symptoms found with PMS. Muscle relaxation techniques and massage therapy may help.

Prevention

• Lifestyle change
• Perform aerobic exercise (if not daily, then 3-4 times a week, even a brisk walk).
• Learn and use stress management techniques such as relaxation, deep breathing, meditation, a warm bath, listening to music, or yoga in your day.
• Limit salt (to help reduce fluid retention, bloating, and swelling especially in your feet and hands).
• Limit caffeine (caffeine can make breast tenderness worse and increase headaches).
• Avoid alcohol (can often affect you differently before your period).
• Eat small meals and snacks spread throughout your day so you don’t go for long periods of time without eating.
• Vitamin therapy
• Vitamin B6 — 100 mg per day maximum (larger doses sometimes cause serious side effects). You can also take a B-complex that includes all the B vitamins. Vitamin B6 may take the edge off irritability and reduce fatigue and depression.
• Vitamin E — 400 IU per day (maximum) may be helpful in reducing breast tenderness.
• Calcium — 1,000-1,200 mg per day of elemental calcium (the labels on foods and supplements give the amount of elemental calcium they contain) may reduce bloating, body aches, anxiety, or depression.
• Magnesium — 400 mg per day in combination with vitamin B6 may reduce pain, water retention, and negative mood.

Outlook

The symptoms of premenstrual syndrome are usually gone within 3-4 days of the start of your period. If you have a severe case of PMS, some doctors will treat you with a variety of medications or with a combination of medicine, diet, and exercise. The only definitive cure for PMS is removal of the uterus and ovaries, which may have many other complications and unwanted long- and short-term consequences. Most women gain benefit from existing therapies without surgery.