Premenstrual syndrome (PMS)

There are no unique physical findings or lab tests to positively diagnose premenstrual syndrome. Your doctor may attribute a particular symptom to premenstrual syndrome (PMS) if it's part of your predictable premenstrual pattern.

To help establish a premenstrual pattern, your doctor may have you record your signs and symptoms on a calendar or in a diary for at least two menstrual cycles. Note the day that you first notice PMS symptoms, as well as the day they disappear. Also be sure to mark the days your period starts and ends.

Certain conditions may mimic PMS, including chronic fatigue syndrome, thyroid disorders and mood disorders, such as depression and anxiety. Your health care provider may order tests, such as a thyroid function test or mood screening tests to help provide a clear diagnosis.

For many women, lifestyle changes can help relieve PMS symptoms. But depending on the severity of your symptoms, your doctor may prescribe one or more medications for premenstrual syndrome.

The success of medications in relieving symptoms varies among women. Commonly prescribed medications for premenstrual syndrome include:

• Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) — which include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and others — have been successful in reducing mood symptoms. selective serotonin reuptake inhibitors (SSRIs) are the first line treatment for severe PMS or premenstrual dysphoric disorder (PMDD). These medications 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, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, 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 water pills (diuretics) can help your body shed excess fluid through your kidneys. Spironolactone (Aldactone) is a diuretic that can help ease some of the symptoms of PMS.
• Hormonal contraceptives. These prescription medications stop ovulation, which may bring relief from PMS symptoms.

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

Modify your diet

• Eat smaller, more-frequent meals 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, a daily calcium supplement may help.
• 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 certain 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 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.

Here's what's known about the effectiveness of complementary remedies used to soothe the symptoms of premenstrual syndrome:

• Vitamin supplements. Calcium, magnesium, vitamin E and vitamin B-6 have all been reported to soothe symptoms, but evidence is limited or lacking.

• Herbal remedies. Some women report relief of PMS symptoms with the use of herbs, such as ginkgo, ginger, chasteberry (Vitex agnus), evening primrose oil and St. John's wort. However, few scientific studies have found that any herbs are effective for relief of PMS symptoms.

  Herbal remedies also aren't regulated by the Food and Drug Administration, so there's no record of product safety or effectiveness. Talk with your doctor before taking any herbal products, as they may have side effects or interact with other medications you're taking. St. John's wort, for example, reduces the effectiveness of birth control pills.

• Acupuncture. A practitioner of acupuncture inserts sterilized stainless steel needles into the skin at specific points on the body. Some women experience symptom relief after acupuncture treatment.

You're likely to start by seeing your family doctor or primary care provider. However, in some cases when you call to set up an appointment, you may be referred to a doctor who specializes in conditions affecting the female reproductive tract (gynecologist).

Here's some information to help you prepare for your appointment and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance to prepare.
• Write down symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of your key medical information, including any other conditions for which you're being treated and the names of any medications, vitamins or supplements you're taking.
• Consider questions to ask your doctor and write them down. Bring along notepaper and a pen to jot down information as your doctor addresses your questions.

For premenstrual syndrome, some basic questions to ask your doctor include:

• Is there anything I can do to minimize PMS symptoms?
• Will my PMS symptoms eventually go away on their own?
• Could the symptoms that I'm experiencing indicate a more serious medical condition?
• Do you recommend treatment for PMS symptoms? What treatments are available?
• Is there a generic alternative to the medicine you're prescribing?
• Do you have any brochures or other printed material that I can take with me? What websites do you recommend?

Don't hesitate to ask any other questions that occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• How severe are your symptoms?
• On what days during your menstrual cycle are your symptoms at their worst?
• Do you have symptom-free days during your menstrual cycle?
• Can you anticipate when your symptoms are coming on?
• Does anything seem to make your symptoms better or worse?
• Do your symptoms interfere with your daily activities?
• Have you recently felt down, depressed or hopeless?
• Have you or has anyone in your family been diagnosed with a psychiatric disorder?
• What treatments have you tried so far? How have they worked?