Premenstrual Syndrome (PMS)

Women who have premenstrual syndrome (PMS) experience a variety of physical and emotional symptoms that occur each month from 2 to 14 days before their menstrual cycle. The symptoms usually disappear once the cycle begins. PMS may begin at any age and ends after menopause. Approximately 75 percent of women experience PMS to some degree with 20 to 50 percent finding that symptoms disrupt their daily activities and 3 to 5 percent becoming incapacitated.

Signs and Symptoms

PMS is often accompanied by the following signs and symptoms.

• Abnormal bloating and weight gain
• Breast swelling tenderness
• Mood swings
• Depression and anxiety
• Skin disorders
• Changes in appetite food cravings
• Changes in interest in sex
• Headaches backaches cramps
• Inability to concentrate loss of interest in usual activities confusion

What Causes It?

While the exact cause of PMS is unknown the most popular theories include hormonal changes (estrogen excess or progesterone deficiency) hypoglycemia (low blood sugar) vitamin B₆ deficiency abnormal metabolism of prostaglandin (hormone-like substances) excessive fluid retention and endorphin (a substance in the brain that provides pain relief) withdrawal.

Who's Most At Risk?

Women with a history of the following conditions are at a higher-than-average risk for having PMS.

• Dysmenorrhea (painful menstruation)
• Depressive mood anxiety or bipolar disorders (family history too)
• Postpartum depression or psychotic episodes
• High stress

What to Expect at Your Provider's Office

If you are experiencing symptoms associated with PMS you should see your health care provider. He or she can help make a diagnosis and guide you in determining which treatment or combination of therapies will work best for you.

You'll need to chart your symptoms and their severity daily for one to two months. Your provider will take a detailed history of symptoms do a physical and gynecologic examination to rule out other medical conditions and conduct a psychosocial evaluation. Certain laboratory and imaging studies may be used such as a Pap smear complete blood count chemistry screen fasting blood glucose test and thyroid studies.

Treatment Options

Prevention

Reducing stress increasing exercise and making dietary changes around the time of menstruation can prevent PMS symptoms from worsening.

Treatment Plan

Preventive measures and in some cases drug therapy are most often used for treating PMS.

Drug Therapies

Your provider may prescribe the following medications.

• Diuretics for bloating and water retention
• Analgesics for headaches and cramps
• Beta-blockers and calcium-channel blockers to prevent the onset of migraine headaches
• Prostaglandin inhibitors for painful menstruation
• Spironolactone for skin conditions
• Medications that block ovulation
• Bromocriptine for breast soreness
• Anti-anxiety medications
• Antidepressants
• Progesterone for relief of symptoms

Women who are planning to become pregnant should avoid medications such as prostaglandin inhibitors diuretics spironolactone and danazol.

Surgical and Other Procedures

Women whose symptoms are severe and do not respond to treatment may need to undergo an hysterectomy including removal of the ovaries followed by estrogen replacement therapy.

Complementary and Alternative Therapies

A comprehensive treatment plan for PMS may include a range of complementary and alternative therapies.

Nutrition

Decreasing or avoiding caffeine (including chocolate) saturated fats sugar salt dairy meat poultry and alcohol can help reduce the intensity and duration of symptoms. Nutritional deficiencies may be addressed with these supplements.

• Vitamin B₆ (100 to 200 mg a day) with B-complex (50 to 100 mg a day)
• Magnesium (400 mg a day)
• Vitamin E (400 to 600 IU a day) especially with breast tenderness
• Essential fatty acids: omega-3 and omega-6 (3 000 to 4 000 mg a day for three months then decrease dose by 1 000 mg every two months)
• Chromium (250 mcg one to two times per day) to reduce sugar cravings

Herbs

Herbal remedies may be helpful in alleviating symptoms. The following herbs should be used in combination either as tincture (60 drops three times a day or tea (1 cup three to four times a day):

• Chaste tree (Vitex agnus castus) (175 mg a day)
• Black cohosh (Cimicifuga racemosa) (100 to 600 mg a day)
• Valerian (Valeriana officinalis) (150 to 300 mg one to four times a day or before bed for insomnia) or kava kava (Piper methysticum) (200 mg one to four times a day or before bed). Reduce dose of either herb if drowsiness occurs.
• Milk thistle (Silybum marianum) (200 to 600 mg a day)
• Dandelion (Taraxacum officinale) root and/or leaves as a tea or tincture can be used as a diuretic. If you have liver problems consult with an experienced practitioner before using dandelion.
• St. John's wort (Hypericum perforatum) (300 mg two to three times per day) for depression associated with PMS. Must be taken consistently throughout the month; direct sun exposure may cause rashes in some people.

Herbs are generally available as dried extracts (pills capsules or tablets) teas or tinctures (alcohol extraction unless otherwise noted). Dose for teas is 1 heaping tsp./cup water steeped for 10 minutes (roots need 20 minutes). For PMS teas or tinctures are preferred.

Homeopathy

An experienced homeopath can prescribe a regimen for treating PMS that is designed especially for you. Some of the most common acute remedies are listed below.

• Belladonna for painful menstruation with profuse bleeding
• Chamomilla for dark clotted blood with pain irritability and restlessness
• Borax for irritability headaches sleeplessness
• Calcarea carbonica for early profuse and long-term bleeding; swollen painful breasts; poor stamina
• Kreosotum for irritability headache nausea and vaginal inflammation
• Nux vomica for irritability cramps food cravings
• Pulsatilla for painful irregular periods with headaches and weepiness
• Sepia for painful scanty menstruation with irritability and an aversion to sex

Acute dose is three to five pellets of 12X to 30C every one to four hours until symptoms are relieved.

Acupuncture

Acupuncture is helpful in balancing hormones and reducing symptoms of PMS including anxiety depression insomnia cramping and fatigue.

Prognosis/Possible Complications

Severe PMS can disrupt a woman's life. Psychological and emotional support as well as treatment of the physical symptoms may help.

Following Up

Ongoing follow-up and regular evaluations are necessary.

Supporting Research

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Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.