Dealing With PMS
Carol E. Watkins, MD
Baltimore, Maryland


Premenstrual Syndrome (PMS) refers to uncomfortable physical and mental symptoms that occur before the onset of the woman’s menstrual period. Estimates of affected women range from 40 to 80%. About 5% of women experience symptoms that cause them severe impairment. PMS may start at any time during the years that a woman menstruates. The peak occurrence is in the 20s and 30s. Once PMS begins, the symptoms often continue until menopause. 

About 150 separate symptoms have been documented, but it is unlikely that any one woman will have all of them. The symptoms can be divided into three general categories.


Changes in Mood or Anxiety

Increased emotional reactivity
Changes in sexual desire
Exacerbation of existing psychiatric condition

Changes in Attention

Difficulty staying on task
Prone to accidents 

Physical Changes

Breast tenderness
Feeling bloated
Swelling in arms and legs
Back pain
Difficulty sleeping
Changes in energy level

Treating Symptoms of PMS 

Lifestyle Changes: Many women find that healthy lifestyle changes decrease symptoms of PMS. Exercise, three to five days per week, improves mood, and increases physical tone. Women who exercise regularly have fewer PMS symptoms. Eating less salt may minimize bloating and swelling. Also helpful is a healthy diet, rich in complex carbohydrates and low in simple sugar. Decreasing caffeine and alcohol intake may help irritability and mood swings. Relaxation techniques, such as meditation or yoga, decrease physical discomfort and stress. 

Self Knowledge: A woman with mild PMS, are able to accept and adjust to her monthly changes in energy and mood. Although parts of the experience are unpleasant, she discovers that it helps her to view things from a different perspective. If she is impulsive or irritable before her menses, she may decide to defer important decisions for a few days. If she feels angry at a friend, she may write down the anger. If, after a few days, it still bothers her, she then responds to the anger. Some women learn this on their own. Others may seek counseling to help reduce stress and to learn ways to actively cope with the PMS. 

Social Support: A supportive spouse or roommate can be a great help during low energy days or periods of irritability. Some women can take turns helping each other during vulnerable times. However, women who live or work closely together often go into synch: they have their menses at the same time. Depending on the situation, this can either be a support or a difficult time for the entire group. 

Vitamins and Minerals: There is some evidence that Calcium may decrease many PMS symptoms.  Moderate doses of Magnesium and Vitamin E may also be helpful. Controlled trials have failed to show nay benefit from high dose Vitamin B6. Additionally, high doses of B6 can cause peripheral nerve damage. 

Treating Physical Symptoms: If lifestyle and dietary changes are not effective, there are other treatments. Diuretics help reduce fluid buildup and decrease bloating. Some women find that oral contraceptives decrease symptoms of PMS. This varies, depending on the dosage and mix of hormones in the particular pill. Non-steroidal Anti-inflammatory Drugs  such as Ibuprofen, are helpful for PMS-associated pain. 

Mood Changes: Marked mood changes are called Premenstrual Dysphoric Disorder. (PMDD) The symptoms of PMDD resemble major depression. A woman with PMDD has her mood swings only in the one to two weeks before her menses. When we suspect PMDD, we often ask the woman to chart her moods for three months. This helps determine whether the mood shifts are confined to the premenstrual days. If depression or other mood shifts also occur in other phases of the cycle, we treat it as any depression, anxiety or bipolar disorder, using psychotherapy or medication.  If charting reveals that depression occurs only before menses, we can choose to treat with medication all month or we may decide to use medication only during the days before menses. The woman should be an active participant in making this decision. Full-cycle treatment is easier to remember. It does not require the same degree of charting and calendar watching. However, if the woman experiences medication side effects, or simply wants to minimize her medication use, she can take an antidepressant during the 10-14 days before her menses. The SSRIs (Prozac, Paxil, Zoloft and others) are the first-line antidepressants for premenstrual depression or irritability. They seem to work more rapidly for PMS mood symptoms than for regular major depression. If a woman has significant manic symptoms before her menses, she may need to take a mood stabilizer such as Lithium or Depakote during her entire cycle. 

Some women find that when the most severe symptoms, mood, or physical symptoms, are addressed; the other symptoms are less intense. Thus, a woman who is successfully treated for premenstrual depression may experience fewer physical symptoms. Other women need active treatment for both kinds of symptoms. 

Premenstrual-type symptoms may temporarily become worse in the perimenopausal period (the years just before menstruation ceases.) However, true menopause often brings the end of premenstrual symptoms.

See our other articles on Women's Mental Health




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Fax: 410-343-1272
Postal address: We have two locations in Baltimore County
      Monkton Office16829 York Road/PO Box 544/Monkton, MD 21111
      Lutherville Office: 2360 West Joppa Road Suite 223/ Lutherville, MD
Email: [email protected]
Please use telephone for appointments or medical questions.

Carol Watkins, M.D.
Glenn Brynes, Ph.D., M.D.
Rita Preller, LCSW-C

Copyright © 2004  Northern County Psychiatric Associates
Last modified: December 14, 2004