Frequently Asked Questions - Gynecology

Click on a Question. Feel free to bring you questions to your doctor. ACOG Patient Education
What are my birth control options? Premenstrual syndrome (PMS) is a term used to describe the abnormal symptoms many women experience one to two weeks before the beginning of their period. Physical symptoms, accompanied by mood swings and depression, are the classic signs. Thirty to forty percent of American women have symptoms severe enough to interfere with their daily lives, while three to five percent have symptoms severe enough to be incapacitating.

PMS symptoms can occur any time after ovulation, approximately two weeks after the beginning of your period.

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Symptoms of PMS
Behavioral
 
  • Increased irritability
  • Feeling anxious
  • Crying spells
  • Depression
  • Forgetfulness
  • Difficulty concentrating
Physical
 
  • Breast swelling or tenderness
  • Headaches
  • A "bloated" feeling or temporary weight gain of a few pounds
  • Nausea or constipation followed by diarrhea at the start of menstruation
  • Acne
  • Swelling of hands or feet
  • Increased appetite or thirst
  • Food cravings
  • Fatigue or insomnia
All PMS symptoms should disappear rapidly once menstruation begins.

Cause PMS has been described as far back as Hippocrates. Modern investigation of PMS began in the early 1930's when it was called "premenstrual tension". To date though, investigators have been unable to find a cause. For many years, research has focused on estrogen and progesterone, two hormones produced by the ovaries. Another theory links serotonin levels (a neurotransmitter in the brain) with PMS symptoms. Other theories that have been advanced - a deficiency of endorphins, defects in the metabolism of glucose or B6, low concentrations of zinc, magnesium or calcium and an imbalance in the body's level of acidity. No conclusive evidence has been found to support any of these theories. Research has found though, that PMS responds to a variety of treatments.

Diagnosis There are no diagnostic tests for PMS. It is generally diagnosed through a process of elimination. To aid in diagnosis, you should keep a diary for several months of symptoms; when they appear, their severity, and when they subside. You and your health care provider then can review your record in order to come up with a treatment plan.

Treatments
Lifestyle and Dietary Changes
 
  • Decrease Caffeine - Caffeine can exaggerate certain PMS symptoms, such as irritability, anxiety, insomnia, and nervousness.
  • Avoid salt - Many women gain a few pounds in the second half of the menstrual cycle due to water retention. Avoiding salty foods can help decrease the bloating. Since brain cells can also retain fluid, decreasing salt may also help headaches and aid in concentration. Along with the sodium reduction it is important to drink at least 8 to 10 glasses of water a day. Water acts as a natural diuretic, along with its normal role in cellular function.
  • Avoid sugar - Eating sugary foods can set off a vicious cycle of sugar cravings. Blood sugar swings can cause a disruption in hormonal production and distribution.
  • Stop smoking - Nicotine can exaggerate PMS symptoms much the same as caffeine.
  • Decrease alcohol intake - Alcohol can intensify symptoms because it depletes the body of B vitamins, disrupts the metabolism of carbohydrates, and affects the liver's ability to process hormones.
  • Increase Calcium - Taking 1200 mg of chewable calcium carbonate a day can decrease symptoms by as much as 50%. Improvements are noted during the third cycle of treatment.
  • Increase Exercise - Women who exercise regularly have milder PMS symptoms. You should participate in some type of aerobic exercise for 20 to 30 minutes at least 3 times a week.
  • Increase Magnesium - 200 mg of Magnesium a day may reduce fluid retention, breast tenderness and bloating by 40%. Improvements are noted during the second cycle of treatment.
  • Medications
     
    • Over the counter PMS preparations - There are a number of OTC PMS medicines available containing a medication for headaches and pain along with a mild diuretic.
    • Oral Contraceptives (Birth Control Pills) - Taking birth control pills or changing prescriptions if already on the pill can decrease symptoms for many women.
    • Spironolactone - A diuretic that has been shown in some studies to decrease bloating and mood-related symptoms.
    • NSAIDS - NSAIDS are prostaglandin inhibitors. They work best if taken before the onset of symptoms. They work on headaches, cramping, and may reduce the amount of blood loss. (Examples of NSAID's available over the counter are Advil, Motrin, Aleve, and Nuprin).
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