Premenstrual Syndrome

Women who have premenstrual syndrome (PMS) experience a variety of physical and emotional symptoms that occur each month from 2 to 14 days before their menstrual cycle. The symptoms usually disappear once the cycle begins. PMS may begin at any age and ends after menopause. Approximately 75 percent of women experience PMS to some degree, with 20 to 50 percent finding that symptoms disrupt their daily activities, and 3 to 5 percent becoming incapacitated.

Signs and Symptoms

PMS is often accompanied by the following signs and symptoms.

What Causes It?

While the exact cause of PMS is unknown, the most popular theories include hormonal changes (estrogen excess or progesterone deficiency), hypoglycemia (low blood sugar), vitamin B6 deficiency, abnormal metabolism of prostaglandin (hormone-like substances), excessive fluid retention, and endorphin (a substance in the brain that provides pain relief) withdrawal.

Who's Most At Risk?

Women with a history of the following conditions are at a higher-than-average risk for having PMS.

What to Expect at Your Provider's Office

If you are experiencing symptoms associated with PMS, you should see your health care provider. He or she can help make a diagnosis and guide you in determining which treatment or combination of therapies will work best for you.

You'll need to chart your symptoms and their severity daily for one to two months. Your provider will take a detailed history of symptoms, do a physical and gynecologic examination to rule out other medical conditions, and conduct a psychosocial evaluation. Certain laboratory and imaging studies may be used, such as a Pap smear, complete blood count, chemistry screen, fasting blood glucose test, and thyroid studies.

Treatment Options


Reducing stress, increasing exercise, and making dietary changes around the time of menstruation can prevent PMS symptoms from worsening.

Treatment Plan

Preventive measures and, in some cases, drug therapy, are most often used for treating PMS.

Drug Therapies

Your provider may prescribe the following medications. Women who are planning to become pregnant should avoid medications such as prostaglandin inhibitors, diuretics, spironolactone, and danazol.

Surgical and Other Procedures

Women whose symptoms are severe and do not respond to treatment may need to undergo a hysterectomy, including removal of the ovaries, followed by estrogen replacement therapy.

Complementary and Alternative Therapies

A comprehensive treatment plan for PMS may include a range of complementary and alternative therapies.

Decreasing or avoiding caffeine (including chocolate), saturated fats, sugar, salt, dairy, meat, poultry, and alcohol can help reduce the intensity and duration of symptoms. Nutritional deficiencies may be addressed with these supplements. Herbs
Herbal remedies may be helpful in alleviating symptoms. The following herbs should be used in combination, either as tincture (60 drops three times a day or tea (1 cup three to four times a day): Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1 heaping tsp./cup water steeped for 10 minutes (roots need 20 minutes). For PMS, teas or tinctures are preferred.

There have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for PMS based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual. Acupuncture
Although scientific evidence regarding the use of acupuncture for PMS is lacking, this condition is frequently treated by acupuncturists. Acupuncturists treat people with PMS based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of PMS, a qi deficiency is usually detected in the liver and/or spleen meridians. Many treatments include moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points), and qualified practitioners may also recommend herbal treatment or dietary modifications.

Some studies suggest that chiropractic spinal manipulation may be effective for women with PMS. Women with PMS have been found to have a higher rate of spine-related problems (such as tenderness and muscle weakness) than those who do not have PMS. In one study, researchers found that women with PMS experience a significant decrease in symptoms after receiving spinal manipulation and soft tissue therapy compared to those who do not receive the chiropractic treatment. The researchers note that these effects may be short-lived and that monthly chiropractic treatment would probably be needed to maintain these positive results.

Prognosis/Possible Complications

Severe PMS can disrupt a woman's life. Psychological and emotional support as well as treatment of the physical symptoms may help.

Following Up

Ongoing follow-up and regular evaluations are necessary.


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