Women, Wellness, & Wisdom

PMS: A Woman’s Monthly Madness

PMS:  A Woman’s Monthly Madness

PMS: A Woman’s Monthly Madness

Vandna Jerath, MD

Dr. Jerath will be discussing this topic live on Denver Channel 7News on June 14, 2011 at 6:30am.

Premenstrual Syndrome (PMS) is defined by the American College of Obstetricians and Gynecologists (ACOG) as “the cyclic occurrence of symptoms that are of sufficient severity to interfere with some aspects of life and that appear with consistent and predictable relationship to the menses.”  Typically, PMS is a syndrome with physical, emotional and/or psychological manifestations.  Symptoms occur after ovulation and are most significant 5-7 days before the menses and subside within 4 days after the onset of menses. 

PMS can affect women of any reproductive age, but is most common between age 25-45.  75 – 85% of women will have at least one symptom or some form of PMS.   Many women will find their symptoms tolerable, but 20-30% will have clinically significant PMS with moderate to severe symptoms that have an adverse affect on their life.  3-5% of women will have debilitating PMS with a disruption of daily, social, and work activities and a significant impairment of their lifestyle.  These women have a severe variant known as PMDD – Premenstrual Dysphoric Disorder. 

Risk factors and the cause of PMS or PMDD are still unknown and research continues, but symptoms are thought to occur due to an imbalance or alteration of cyclic physiologic hormones and brain chemicals known as neurotransmitters, particularly an insufficient amount of serotonin.

Symptoms include an affective or mood component and/or a somatic or physical component: 

Emotional/Mood Symptoms

  • Crying

  • Angry outbursts or mood swings

  • Depressed mood

  • Anxiety

  • Irritability

  • Social withdrawal

  • Poor concentration

Physical Symptoms

  • Breast tenderness

  • Bloating

  • Constipation

  • Weight gain

  • Swelling

  • Acne

  • Headache

  • Fatigue

  • Sleep disturbances – insomnia or hypersomnia

  • Appetite changes/food cravings


PMS can mimic several medical conditions including hypothyroidism, irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia, migraines, and depression/mood disorders.  The best way to diagnose PMS is to keep a comprehensive menstrual diary outlining symptoms for 2-3 cycles.  If symptoms typically occur after ovulation, before menses, and resolve after menses, they are consistent with PMS.  A variety of menstrual diaries can be found on the internet or most smart phones will have a useful app for charting. 

There is no “cure” for PMS, but there are multiple options to reduce PMS symptoms.  Treatment regimens include lifestyle modifications, alternative therapies, and medications:

Lifestyle Modifications

  • Stress reduction and support

  • Relaxation

  • Aerobic exercise – release endorphins which improve mood

  • Healthy diet –

    • Smaller and frequent meals

    • Reduce sugar and fat intake

    • Increase complex carbohydrates (whole grains, fruits, vegetables)

    • Calcium rich foods

    • B vitamins – thiamine and riboflavin (spinach, fortified cereal, dried beans, red meat)

  • Reduction in caffeine, salt, and alcohol

  • Quit smoking

Alternative/Natural Therapies

  • Vitamins

    • Calcium – 1200 mg daily

    • B6 – 50-100mg daily (doses over 100mg can cause peripheral neuropathy)

    • Magnesium – 400mg daily

    • Vit E – 400 IU daily

  • Herbs – not FDA approved or regulated and may react with other prescription medications; may still require further investigation

    • Chasteberry

    • Gingko Biloba

    • Black Cohosh

    • Raspberry Leaf

    • St John’s Wart (may reduce efficacy of OCPs)

    • Kava Kava

    • Primrose Oil – not particularly helpful

  • Massage Therapy

  • Yoga

  • Acupuncture

  • Psychotherapy – cognitive behavioral therapy

  • Light therapy – being researched


  • Analgesics or NSAIDs

    • Ibuprofen (Motrin, Advil)

    • Naproxen (Aleve, Anaprox)

    • Mefenamic Acid (Ponstel)

  • Oral Contraceptives (OCP’s)

    • Drosperinone (Yaz, Yasmin, Safryl, BeYaz, Ocella)

  • Diuretics

    • Spironolactone (Aldactone)

  • Ovarian Suppression

    • Danacrine (Danazol)

    • GnRH analogs – gonadotropin releasing hormone (Lupron) – cannot be given for more than 6 months and may lead to menopausal symptoms and osteoporosis

  • Antidepressants /Anxiolytics

    • SSRI – selective serotonin reuptake inhibitors

      • Fluoxetine (Prozac, Sarafem)

      • Paroxetine (Paxil)

      • Sertraline (Zoloft)

      • Citalopram  (Celexa)

      • Venlafaxine (Effexor)

      • Duloxetine (Cymbalta)

      • Benzodiazepine

        • Alprazolam (Xanax) – increased risk for addiction

  • Other

    • PH80 – pherine intranasal spray in clinical trials now

    • Bilateral Salpingoopherectomy – removal of ovaries, extreme measure

PMS is definitely a woman’s monthly madness and many women live in silent suffering.  But, with proper recognition, communication, and understanding between the patient and doctor, there are many options that can improve quality of life. 



Photo Credit: Stock Photo

4 thoughts on “PMS: A Woman’s Monthly Madness

  1. Bartholomew John

    I have a relatively new blog/forum where I posted an excerpt of this article with a link back here.That way my site will eventually gain curator status for medical articles and hopefully also bring more traffic to your site.

  2. Janmar Delicana

    Dear Dr. Jerath,
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    As a reader, I consider your writing to be a great example of a quality and globally competitive output. It would be a great thrill and honor if you could share your genuine ideas and knowledge to our community, Physician Nexus. With this you can gain 1000 physician readers from over 62 countries on Nexus.
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    On behalf of the Physician Nexus Team

  3. Pingback: Women's Health after 40: important things every woman should know | Dr. Jerath

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