What is PMS?
Premenstrual syndrome, or PMS, is a group of symptoms that start one to two weeks before menstruation. Most women have at least some symptoms of PMS, and the symptoms go away after their periods start. For some women, the symptoms are severe enough to interfere with their lives, which is a type of PMS called premenstrual dysphoric disorder (PMDD).[1]
What are the main signs and symptoms of PMS?
Common PMS symptoms are as follows:[1]
- Breast swelling and tenderness
- Acne
- Bloating and weight gain
- Headache or joint pain
- Food cravings
- Irritability, mood swings, crying spells, depression
How is PMS diagnosed?
PMS is usually diagnosed if at least one of the symptoms listed above occurs during the five days before the start of menses for at least three cycles, two of which must be consecutive cycles. Additionally, these symptoms stop at least four days after the onset of menses and do not recur until the next cycle.[2]
What are some of the main medical treatments for PMS?
Over-the-counter pain relievers such as ibuprofen, naproxen, or acetaminophen may help ease mild PMS symptoms (e.g., cramps, headaches, breast tenderness). When symptoms of PMS are severe, selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa), or sertraline (Zoloft) can be tried. Oral contraceptives have also shown some benefit for reducing PMS symptoms. Theoretically, these work by regulating fluctuations of estrogen and progesterone throughout a cycle.[2]
Have any supplements been studied for PMS?
Daily calcium supplements (calcium carbonate) have been shown to reduce symptoms of PMS. Vitamin D and vitamin B6 have also been assessed for PMS symptoms, but there is insufficient evidence to support their use.[2] Many herbs have also been studied, with chasteberry having the greatest volume of evidence behind it.[3]
How could diet affect PMS?
Specific diets have not been studied for PMS. Some observational evidence has found that consuming foods high in calcium, vitamin D, thiamine, and riboflavin has been associated with a lower risk of PMS.[4][5] Common dietary recommendations for PMS include small and frequent meals as well as reducing consumption of salt, caffeine, and refined sugars. These modifications are intended to reduce irritability, insomnia, fluid retention, bloating, and weight gain during PMS.[6]
Are there any other treatments for PMS?
Exercise is often recommended for PMS because it can promote endorphin release which can improve mood and increase energy.[6] Psychological modalities such as cognitive-behavioral therapy (CBT) and other modalities such as acupuncture with and without herbal medicine have been studied for relieving PMS symptoms. However, more research is needed to determine their benefits. [2]
What causes PMS?
No one knows what causes PMS. It is likely that changes to the levels of estrogen and progesterone and individual sensitivity to these changes trigger PMS symptoms. These hormones affect levels of neurotransmitters such as gamma-aminobutyric acid, dopamine, and serotonin which in turn can affect mood. Some evidence suggests that suppressing estrogen can improve PMS symptoms,[2] and a deficiency of progesterone may worsen symptoms, but more research is needed.[7]
Examine Database: Premenstrual Syndrome (PMS)
Research FeedRead all studies
In this randomized controlled trial, adolescents in the Middle Eastern country of Oman were given dietary counseling for 2 months to try to reduce premenstrual symptoms. However, there were no improvements in health outcomes at the conclusion of the study.
Frequently asked questions
Premenstrual syndrome, or PMS, is a group of symptoms that start one to two weeks before menstruation. Most women have at least some symptoms of PMS, and the symptoms go away after their periods start. For some women, the symptoms are severe enough to interfere with their lives, which is a type of PMS called premenstrual dysphoric disorder (PMDD).[1]
Some research has found that PMS symptoms are reported in about 50% of women of reproductive age, while in other research, PMS symptoms are reported in up to 90% of younger women. The rates of PMS vary greatly between different geographic regions. For example, PMS is reported in about 34% of young adult women (attending university) in China, 40% in Taiwan, 65% in Egypt, 79% in Japan, and up to 92% in Turkey.[7] In other research, PMS is reported in up to 30% of women living in the United States, 12% in France, and up to 98% in Iran.[8] Why do different countries have such different rates of PMS and PMS symptoms? No one knows for sure. Some theories include differences in lifestyle and genetic factors, community practices during the time of menstruation, and diagnostic criteria and investigation methods.[7][8]
Common PMS symptoms are as follows:[1]
- Breast swelling and tenderness
- Acne
- Bloating and weight gain
- Headache or joint pain
- Food cravings
- Irritability, mood swings, crying spells, depression
PMS is usually diagnosed if at least one of the symptoms listed above occurs during the five days before the start of menses for at least three cycles, two of which must be consecutive cycles. Additionally, these symptoms stop at least four days after the onset of menses and do not recur until the next cycle.[2]
Over-the-counter pain relievers such as ibuprofen, naproxen, or acetaminophen may help ease mild PMS symptoms (e.g., cramps, headaches, breast tenderness). When symptoms of PMS are severe, selective serotonin reuptake inhibitors (SSRIs) such as paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa), or sertraline (Zoloft) can be tried. Oral contraceptives have also shown some benefit for reducing PMS symptoms. Theoretically, these work by regulating fluctuations of estrogen and progesterone throughout a cycle.[2]
Daily calcium supplements (calcium carbonate) have been shown to reduce symptoms of PMS. Vitamin D and vitamin B6 have also been assessed for PMS symptoms, but there is insufficient evidence to support their use.[2] Many herbs have also been studied, with chasteberry having the greatest volume of evidence behind it.[3]
Several small and heterogeneous clinical studies suggest that daily supplementation with 500–1,200 milligrams of calcium for up to 3 menstrual cycles improves PMS symptoms such as bloating, food cravings, and pain when compared to placebo. Also, several observational studies have found that PMS symptoms are associated with lower total calcium levels. It is possible that calcium levels are reduced during menstruation, precipitating PMS symptoms. Estrogen may lower calcium in the blood by inhibiting bone resorption. During the menstrual cycle, estrogen has two peaks: right before the luteinizing hormone surge and during the luteal phase. Theoretically, the peaks in estrogen lower total calcium levels. In some, the lower blood calcium levels can increase parathyroid hormone levels and lower calcium levels in the smooth muscle, which in turn might precipitate PMS symptoms such as cramping and pain.[9]
Specific diets have not been studied for PMS. Some observational evidence has found that consuming foods high in calcium, vitamin D, thiamine, and riboflavin has been associated with a lower risk of PMS.[4][5] Common dietary recommendations for PMS include small and frequent meals as well as reducing consumption of salt, caffeine, and refined sugars. These modifications are intended to reduce irritability, insomnia, fluid retention, bloating, and weight gain during PMS.[6]
Exercise is often recommended for PMS because it can promote endorphin release which can improve mood and increase energy.[6] Psychological modalities such as cognitive-behavioral therapy (CBT) and other modalities such as acupuncture with and without herbal medicine have been studied for relieving PMS symptoms. However, more research is needed to determine their benefits. [2]
No one knows what causes PMS. It is likely that changes to the levels of estrogen and progesterone and individual sensitivity to these changes trigger PMS symptoms. These hormones affect levels of neurotransmitters such as gamma-aminobutyric acid, dopamine, and serotonin which in turn can affect mood. Some evidence suggests that suppressing estrogen can improve PMS symptoms,[2] and a deficiency of progesterone may worsen symptoms, but more research is needed.[7]
References
Examine Database References
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- Irritability - Momoeda M, Sasaki H, Tagashira E, Ogishima M, Takano Y, Ochiai KEfficacy and safety of Vitex agnus-castus extract for treatment of premenstrual syndrome in Japanese patients: a prospective, open-label studyAdv Ther.(2014 Mar)
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- PMS Symptoms - Anna Ambrosini, Cherubino Di Lorenzo, Gianluca Coppola, Francesco PierelliUse of Vitex agnus-castus in migrainous women with premenstrual syndrome: an open-label clinical observationActa Neurol Belg.(2013 Mar)
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- PMS Symptoms - R SchellenbergTreatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled studyBritish Medical Journal.()
- Irritability - Sampalis F, Bunea R, Pelland MF, Kowalski O, Duguet N, Dupuis SEvaluation of the effects of Neptune Krill Oil on the management of premenstrual syndrome and dysmenorrheaAltern Med Rev.(2003 May)
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- PMS Symptoms - Thys-Jacobs S, Ceccarelli S, Bierman A, Weisman H, Cohen MA, Alvir JCalcium supplementation in premenstrual syndrome: a randomized crossover trialJ Gen Intern Med.(1989 May-Jun)
- PMS Symptoms - Samieipour, s, et alEFFECT OF CALCIUM AND VITAMIN B1 ON THE SEVERITY OF PREMENSTRUAL SYNDROME: A RANDOMIZED CONTROL TRIALInt J Pharm Tech.()
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- Depression Symptoms - Agha-Hosseini M, Kashani L, Aleyaseen A, Ghoreishi A, Rahmanpour H, Zarrinara AR, Akhondzadeh SCrocus sativus L. (saffron) in the treatment of premenstrual syndrome: a double-blind, randomised and placebo-controlled trialBJOG.(2008 Mar)
- PMS Symptoms - Beiranvanda S, et alThe effect of Crocus sativus (saffron) on the severity of premenstrual syndromeEur J Integr Med.()
- Anxiety Symptoms - Fukui H, Toyoshima K, Komaki RPsychological and neuroendocrinological effects of odor of saffron (Crocus sativus)Phytomedicine.(2011 Jun 15)
- Depression Symptoms - Ebrahimi E, Khayati Motlagh S, Nemati S, Tavakoli ZEffects of magnesium and vitamin b6 on the severity of premenstrual syndrome symptomsJ Caring Sci.(2012 Nov 22)
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- PMS Symptoms - Facchinetti F, Borella P, Sances G, Fioroni L, Nappi RE, Genazzani AROral magnesium successfully relieves premenstrual mood changesObstet Gynecol.(1991 Aug)
- PMS Symptoms - Quaranta S, Buscaglia MA, Meroni MG, Colombo E, Cella SPilot study of the efficacy and safety of a modified-release magnesium 250 mg tablet (Sincromag) for the treatment of premenstrual syndromeClin Drug Investig.(2007)
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- PMS Symptoms - London RS, Sundaram G, Manimekalai S, Murphy L, Reynolds M, Goldstein PThe effect of alpha-tocopherol on premenstrual symptomatology: a double-blind study. II. Endocrine correlatesJ Am Coll Nutr.(1984)
- PMS Symptoms - Heidari H, Amani R, Feizi A, Askari G, Kohan S, Tavasoli PVitamin D Supplementation for Premenstrual Syndrome-Related inflammation and antioxidant markers in students with vitamin D deficient: a randomized clinical trialSci Rep.(2019 Oct 17)
- PMS Symptoms - Bahrami A, Avan A, Sadeghnia HR, Esmaeili H, Tayefi M, Ghasemi F, Nejati Salehkhani F, Arabpour-Dahoue M, Rastgar-Moghadam A, Ferns GA, Bahrami-Taghanaki H, Ghayour-Mobarhan MHigh dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescentsGynecol Endocrinol.(2018 Aug)
- PMS Symptoms - Abdollahi R, Abiri B, Sarbakhsh P, Kashanian M, Vafa MThe Effect of Vitamin D Supplement Consumption on Premenstrual Syndrome in Vitamin D-Deficient Young Girls: A Randomized, Double-Blind, Placebo-Controlled Clinical TrialComplement Med Res.(2019)
- PMS Symptoms - Tartagni M, Cicinelli MV, Tartagni MV, Alrasheed H, Matteo M, Baldini D, De Salvia M, Loverro G, Montagnani MVitamin D Supplementation for Premenstrual Syndrome-Related Mood Disorders in Adolescents with Severe Hypovitaminosis DJ Pediatr Adolesc Gynecol.(2016 Aug)
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- PMS Symptoms - Jafari F, Amani R, Tarrahi MJEffect of Zinc Supplementation on Physical and Psychological Symptoms, Biomarkers of Inflammation, Oxidative Stress, and Brain-Derived Neurotrophic Factor in Young Women with Premenstrual Syndrome: a Randomized, Double-Blind, Placebo-Controlled TrialBiol Trace Elem Res.(2019 Jun 2)
- Depression Symptoms - Gianfranco C, Vittorio U, Silvia B, Francesco DMyo-inositol in the treatment of premenstrual dysphoric disorderHum Psychopharmacol.(2011 Oct)
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- PMS Symptoms - Williams MJ, Harris RI, Dean BCControlled trial of pyridoxine in the premenstrual syndromeJ Int Med Res.(1985)
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