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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Spanish version
Premenstrual Syndrome (PMS) and Premenstrual Dysphoric
Disorder (PMDD)
What is premenstrual syndrome (PMS)?
Premenstrual syndrome is the physical and emotional symptoms
that some women have before their menstrual period begins.
Premenstrual syndrome is commonly called PMS. At least 75%
of all menstruating women have some symptoms of PMS.
Symptoms vary from woman to woman and may be mild to severe.
What is premenstrual dysphoric disorder (PMDD)?
Premenstrual dysphoric disorder (PMDD) is a very severe form
of premenstrual syndrome.
PMDD includes severe physical, emotional, and
quality-of-life problems. About 5% to 10% of women have PMDD before
each menstrual period begins. Severe symptoms, such as
anger that is out of control, seriously disrupt daily life.
How does it occur?
PMS and PMDD are related to hormonal changes during the
menstrual cycle. A single cause has not been found.
Researchers are checking the effects of a woman's sex
hormones on brain chemistry and other aspects of body
metabolism. They are looking at levels of testosterone in
women that may lead to the more severe symptoms of PMDD.
Some scientists think PMDD may be caused by an imbalance of
a chemical in the body called serotonin.
What are the symptoms?
PMS and PMDD symptoms usually occur during the second half
of your menstrual cycle. Often the symptoms start a few
days before your menstrual period, but they may start as
much as 2 weeks before your period. Physical symptoms are
the same for PMS and PMDD. With PMDD, however, the
emotional symptoms are much more serious. You may feel very
depressed and hopeless.
Physical symptoms may include:
- bloated stomach
- swollen feet or hands
- tender, enlarged breasts
- crampy pain in the lower abdomen
- weight gain
- headache
- nausea, vomiting, diarrhea, constipation
- appetite changes
- joint or muscle pain
- acne.
Emotional symptoms may include:
- irritability
- anger
- depression
- anxiety
- tension
- fatigue, lack of energy
- difficulty concentrating
- crying spells
- feeling overwhelmed or out of control
- lack of or decrease in sex drive.
Many women who have PMS also experience difficulties in
their relationships with families and friends. With PMDD,
these difficulties are severe.
How is it diagnosed?
PMS or PMDD cannot be diagnosed from any one physical exam
or lab test. Your health care provider will ask you to keep
a daily log of your mood and physical symptoms for 2 months.
A log is very important to find out if you have PMDD.
Symptoms that always appear 1 to 2 weeks before your periods
may be caused by PMS or PMDD. For you to be diagnosed with
PMDD, your monthly symptoms must significantly interfere
with work, school, or relationships.
Diagnosis can be difficult and may take several months of
careful observation.
How is it treated?
No one therapy works for all women. Aerobic exercise, rest,
stress reduction, and less salt, caffeine, and refined sugar
in your diet may help.
Psychotherapy
Counseling may help you deal with your emotional or
relationship difficulties. Cognitive behavioral therapy may
also help with PMDD.
Medicine
Anti-inflammatory drugs, such as ibuprofen and naproxen, can
help most premenstrual cramping and headaches. If your
cramps are severe, you may need to start taking the
anti-inflammatory drugs 1 to 2 days before you expect your cramps
to begin. This can prevent the production of cramp-causing
chemicals by your body. These drugs can also help prevent
the nausea, vomiting, and diarrhea caused by the same
chemicals. You may need prescription medicine for PMS
headaches.
Your health care provider may prescribe a mild diuretic
(water pill) for bloating and swelling. If you have severe
breast symptoms, your provider may prescribe medicine that
might help.
Prescription medicine is available for the treatment of
PMDD. Research has shown that fluoxetine (Prozac, Sarafem),
sertraline (Zoloft), or paroxetine HCl (Paxil) can help.
These drugs reduce aggression and irritability. Medicines
for this disorder help 60% to 70% of women with PMDD.
Leuprolide (Lupron), which suppresses the sex hormones, may
also help.
Natural Remedies and Alternative Treatments
To reduce breast tenderness and swelling, do not eat
chocolate or drink beverages containing caffeine. You may
need to cut these foods from your diet completely or you may
need to avoid them only during the last half of your
menstrual cycle.
Limit the salt in your diet during the last half of your
menstrual cycle to reduce problems of bloating and swelling.
Nutritional supplements are often recommended for mild to
moderate PMS symptoms:
- calcium
- vitamin B6
- vitamin E
- tryptophan.
Acupuncture may provide relief for headaches, fatigue,
depression, backache, and other symptoms of PMS and PMDD.
How long will the effects last?
The symptoms of PMS usually start a few days before your
menstrual period and continue until your period begins. You
may keep having symptoms during your period. The symptoms
of PMS change as you mature, go through childbearing age,
and enter menopause.
How can I take care of myself?
- Know how and when PMS affects you. You can then change
your diet, exercise, and schedule in ways that help PMS
to pass as smoothly as possible.
- If you have PMDD, make sure you get medical and
psychological treatment.
- Join a support group for women dealing with the
challenges of PMS or PMDD.
- Call your health care provider if you have severe
symptoms or notice that your symptoms vary from one month
to the next. There may be a more serious cause of your
symptoms that needs treatment.
What can I do to help prevent PMS and PMDD?
There is no reliable way to prevent PMS and PMDD because the
cause of these disorders has not been identified. You may
be able to lessen the symptoms if you eat a healthy diet,
maintain a normal weight, exercise regularly, and take
anti-inflammatory drugs when necessary. If these measures fail,
ask your health care provider about prescription treatments.
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