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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Women's Health Premenstrual syndrome

Premenstrual syndrome

Premenstrual Syndrome is a condition which affects many women during the one or two weeks before menstruation begins. It is characterised by troublesome but usually harmless symptoms including breast tenderness, mood swings, bloating, depression and backache.



The most common signs and symptoms associated with premenstrual syndrome include:

Emotional and behavioral symptoms:

  • Tension or anxiety
  • Depressed mood
  • Crying spells
  • Mood swings and irritability or anger
  • Appetite changes and food cravings
  • Trouble falling asleep (insomnia)
  • Social withdrawal
  • Poor concentration

Physical signs and symptoms:

  • Joint or muscle pain
  • Headache
  • Fatigue
  • Weight gain from fluid retention
  • Abdominal bloating
  • Breast tenderness
  • Acne flare-ups
  • Constipation or diarrhea
  • For some women, the physical pain and emotional stress are severe enough to affect their daily routines and activities. For most of these women, signs and symptoms disappear as the menstrual period begins.
  • But a small proportion of women with premenstrual syndrome have disabling symptoms every month. This form of PMS has its own psychiatric designation — premenstrual dysphoric disorder (PMDD). 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. A number of women with severe PMS may have an underlying psychiatric disorder.


  • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft) and others, have been successful in reducing symptoms such as fatigue, food cravings and sleep problems and are the first line agents for treatment of severe PMS or PMDD. These drugs are generally taken daily. But for some women with PMS, use of antidepressants may be limited to the two weeks before menstruation begins.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Taken before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin, others) or naproxen sodium (Aleve) can ease cramping and breast discomfort.
  • Diuretics: When exercise and limiting salt intake aren't enough to reduce the weight gain, swelling and bloating of PMS, taking diuretics, or water pills, can help your body shed excess water through your kidneys. Spironolactone is a diuretic that can help ease some of the symptoms of PMS.
  • Oral contraceptives: These prescription medications stop ovulation and stabilize hormonal swings, thereby offering relief from PMS symptoms. Yaz, a type of birth control pill containing the progestin drospirenone, which acts similarly to the diuretic spironolactone, has been shown to be even more effective than regular birth control pills are in reducing the physical and emotional symptoms of PMS and PMDD.
  • Medroxyprogesterone acetate (Depo-Provera): For severe PMS or PMDD, this injection can be used to temporarily stop ovulation. However, Depo-Provera may cause an increase in some signs and symptoms of PMS, such as increased appetite, weight gain, headache and depressed mood.

Lifestyle and home remedies:

You can manage or sometimes reduce the symptoms of premenstrual syndrome by making changes in the way you eat, exercise and approach daily life. Try these approaches:

Modify your diet:

  • Eat smaller, more frequent meals each day to reduce bloating and the sensation of fullness.
  • Limit salt and salty foods to reduce bloating and fluid retention.
  • Choose foods high in complex carbohydrates, such as fruits, vegetables and whole grains.
  • Choose foods rich in calcium. If you can't tolerate dairy products or aren't getting adequate calcium in your diet, you may need a daily calcium supplement.
  • Take a daily multivitamin supplement.
  • Avoid caffeine and alcohol.

Incorporate exercise into your regular routine:

Engage in at least 30 minutes of brisk walking, cycling, swimming or other aerobic activity most days of the week. Regular daily exercise can help improve your overall health and alleviate symptoms such as fatigue and a depressed mood.

Reduce stress:

  • Get plenty of sleep.
  • Practice progressive muscle relaxation or deep-breathing exercises to help reduce headaches, anxiety or trouble sleeping (insomnia).
  • Try yoga or massage as ways to relax and relieve stress.
  • Record your symptoms for a few months.
  • Keep a record to identify the triggers and timing of your symptoms. This will allow you to intervene with strategies that may help to lessen them.