Dealing with PMS



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


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




Difficulty staying on task

Prone to accidents 





Feeling bloated

Swelling in arms and legs


Back pain

Difficulty sleeping

Changes in energy level



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


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


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. 


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.

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Women’s Mental Health