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Premenstrual syndrome Causes, Symptoms and Treatment

The premenstrual syndrome (PMS)is a set of physical and emotional symptoms that usually occur 2 to 7 days before menstruation (sometimes up to 14 days). They usually end with the arrival of the rules or within a few days.

The most common symptoms are pronounced fatigue , sensitive and swollen breasts , swellingof the lower abdomen , headaches and irritability .

The intensity of the symptoms as well as their duration varies a lot from one woman to another.

How many women affected?

Nearly 75% of fertile women experience mild symptoms the day before or when they are menstruating, such as mild cramping of the uterus. This does not prevent them from continuing their normal activities and, after all, it is not a problem. From 20% to 30% of women have symptoms severe enough to interfere with daily activities.

The premenstrual dysphoric disorder (PMDD) is a PMS including psychological symptoms are very pronounced. It would affect 2% to 6% of women.

Diagnostic of Premenstrual syndrome

The criteria for diagnosing premenstrual syndrome have long remained unclear. A new classification by the International Society for Premenstrual Disorders (ISPMD) clarifies the situation. Thus, it has been established that in order to diagnose premenstrual syndrome, the symptoms must have manifested themselves during the majority of the menstrual cycles of the past year. In addition, symptoms should be completely absent for at least 1 week per month.

Some situations may at first glance be mistaken for premenstrual syndrome, such as premenopause and depression.

Causes of Premenstrual syndrome

The exact causes of this phenomenon are still poorly understood. It is known that PMS is related to ovulationand the menstrual cycle. One of the explanations is the typical hormonal fluctuation of the second part of the menstrual cycle: while the secretion of estrogen decreases, that of progesterone increases, then falls in turn in the absence of pregnancy. Estrogens cause breast swelling and fluid retention, which progesterone normally reduces. However, if there is an excess of estrogen or a deficiency of progesterone, there is a painful tension in the breasts. In addition, the fluctuations of these 2 hormones are perceived by the brain and can explain the psychological symptoms. There could also be a fluctuation of neurotransmitters in the brain ( especially serotonin ), following the hormonal fluctuations of the menstrual cycle.

PMS symptoms

Most women with premenstrual syndrome may experience many of the symptoms mentioned here, but not necessarily all of them.

  • Emotional symptoms  : mood changes, irritability, anxiety, difficulty concentrating, feeling depressed or depressed;
  • A pronounced tiredness;
  • Sleep disorders (insomnia or hypersomnia );
  • Headaches or migraines;
  • A decrease in sexual desire;
  • Cravings for sweet or salty foods;
  • Abdominal cramps (due to spasms of the uterus);
  • Muscle pain, especially in the lower back;
  • Symptoms caused by water retention  : swelling of the lower abdomen, tender and swollen breasts, sore legs or heavy legs, weight gain;
  • An acne breakout.
Premenstrual syndrome can intensify the symptoms of other health problems . Migraines or chronic pain can be stronger and difficult to bear but also attacks of asthma, epilepsy or allergies.

People at risk for Premenstrual syndrome

Women with a family history of premenstrual syndrome (an infected mother or sister).

Risk factors

The following factors would increase the risk of PMS or worsen the symptoms.

  • Smoking;
  • Physical inactivity;
  • Lack of sleep;
  • Obesity;
  • A diet too rich in caffeine and alcohol (which affect the sensitivity of the brain to stress), red meat, sugar (carbohydrates) and low in calcium.

Note that stress can accentuate the symptoms of PMS.

Preventing premenstrual syndrome

Measures to prevent or mitigate PMS symptoms
Physical exercise

Regular exercise , throughout the month (20 to 30 minutes a day, 3 to 5 times a week) and not just the few days of premenstrual symptoms, results in a general improvement.

The aerobic exercise (walking, swimming, bicycling, jogging, dancing, etc.), in particular, increase blood flow to various organs and thus help regulate fluctuations of sex hormones. In addition to bringing a sensation of well-being and pleasure, physical activity releases the accumulated energy overload in case of stress or, on the contrary, refueling if necessary.


  • Take 3 balanced meals daily , at regular times, without skipping meals. This helps to maintain a stable sugar level;
  • Have a good daily intake of calcium and magnesium . To find out which foods contain them and what are the recommended dietary intakes, consult our Calcium and Magnesium sheets;
  • If necessary, reduce caffeine consumption in all its forms (coffee, tea, chocolate, coffee ice cream, cola-type soft drinks, energy drinks, hot chocolate, etc.);
  • Eat foods high in slow carbohydrates and dietary fiber (such as whole grain bread, fruits and vegetables, pasta and whole grains). This prevents sugar cravings . Excess refined sugar (cookies, pastries and other commercially prepared desserts, white flour breads, sweetened cereals, etc.) causes a rapid rise followed by a sharp drop in blood glucose, which disrupts the metabolism ;
  • If necessary, reduce salt intake . This overcomes the problems of water retention . Indeed, when we ingest a lot of salt, the kidneys react by retaining the water to maintain a stable sodium concentration in the body. Replace table salt with herbs or spices. Consume moderately prepared dishes, chips, sauces and commercial soups, etc.

Stress: fighting it

Given the stressful climate that PMS causes, it is desirable not to overload one’s schedule during critical days. Try to find solutions to better deal with situations that generate stress (reorganize your schedule, resolve a conflict, etc.). Any approach that provides a state of relaxation is a useful supplement (deep breathing, meditation, yoga, massage, etc.).

Medical treatment of premenstrual syndrome

The effectiveness of treatmentsvaries from woman to woman. Solutions can work wonders for some women and give no results for others. Sometimes you have to try a few treatments before finding the right one. A trial period of 3 months is suggested.

Life habits

The lifestyle changes suggested in the Prevention section are often enough to provide some comfort to women with mild or moderate symptoms.


When a healthy lifestyle is not enough to relieve symptoms, medications can be used. Nevertheless, the drug strategy must always be combined with a healthy lifestyle.

Nonsteroidal anti-inflammatory drugs (NSAIDs). They relieve cramps and reduce the sensitivity of the breasts. To be effective, they must be taken during the week before menstruation and the first days of menstruation. Ibuprofen (Advil, Motrin) and naproxen (Anaprox, Naprosyn) are the most commonly used in these situations.
Attention . NSAIDs should not be used at the same time as diuretics (see below).

Oral contraceptives continuously. In addition to acting as a contraceptive, this is a good way to stop PMS because ovulation is prevented. This option is interesting, for example, in case of intense migraines at the end of the cycle or during the rules. All pills can be taken continuously but some have been designed for this purpose (eg Seasonale).

Estrogen and progestin patches . Taking estrogen has been effective for many women. It must be accompanied by taking a progestin to avoid the side effects of estrogen alone. This method is not contraceptive and pregnancy is not recommended when estrogens are used in the form of patches. Therefore, contraception should be used during sexual intercourse (for example, condoms or a Mirena IUD).

Antidepressants. Two families of antidepressants, selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors, can effectively relieve some symptoms of premenstrual syndrome (particularly irritability ). It is usually suggested to take antidepressants during the 2 weeks before the period. The dosage is lower than for the treatment of depression.

Diuretics. These medications help eliminate fluid and may decrease symptoms related to fluid retention (weight gain, leg or leg pain, etc.). Because of their potentially significant side effects, they are almost no longer used for the treatment of PMS, except in rare cases. Spironolactone (Aldactone) is the only diuretic to be used for this indication. A diet low in salt is often enough to limit water retention.

Anxiolytics. Previously proposed, anxiolytics (eg, alprazolam and buspirone) are now strongly discouraged because they are less effective than antidepressants and can create dependence or other undesirable effects.

In case of very severe symptoms that are not relieved by other methods, it is possible to resort to drugs that stop menstruation (androgens, such as danazol or Gn-RH analogues). These are hormones that cause temporary menopause. The duration of the treatment does not exceed 6 months. As a last resort, some women opt for surgical removal of the ovaries.

Food supplements

Physicians are increasingly recommending calcium and magnesium supplements to women with premenstrual syndrome because studies have shown that these minerals have beneficial effects (see Complementary Approaches ). Researchers believe that premenstrual syndrome may be, in part, a manifestation of calcium deficiency.

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Updated: April 18, 2018 — 3:30 pm
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