Premenstrual Syndrome (PMS) – When Does PMS Start?

PMS treatment

There is no cure for PMS, but taking medicine may help. No single PMS treatment works for everyone, according to the National Institutes of Health (NIH). Consider taking over-the-counter pain relievers, such as ibuprofen, aspirin, or naproxen, to help ease cramps, headaches, backaches, and breast tenderness. Depending on your PMS symptoms and how severe they are, your doctor may prescribe medicine for you.

You may need to try more than one medicine to find the treatment that works best for you. Medicines that your doctor can prescribe include diuretics, antidepressants, and birth control pills.

What are diuretics?

Diuretics help your body get rid of extra sodium and fluid. They can ease bloating, weight gain, breast pain, and abdominal pain. Diuretics usually are taken just before you would normally experience these symptoms in your menstrual cycle and can be stopped when they are no longer needed.

Do antidepressants help?

Antidepressants can help with the severe irritability, depression, and anxiety that some women experience as part of PMS. These medicines are usually taken every day, even when you feel fine.

What about birth control pills?

Your doctor may talk to you about taking birth control pills (often just called “the pill”) to help ease some of your PMS symptoms. Birth control pills help by evening out your hormone levels throughout your cycle. Some women’s PMS symptoms get a lot better when they take birth control pills. However, the pill can also cause side effects of its own, and it doesn’t help all women.

What about medicines I can buy without a prescription?

You can buy medicines without a prescription to help with the symptoms of PMS. These medicines usually combine aspirin or acetaminophen with caffeine, antihistamines, or diuretics. Some brand names include Midol, Pamprin, and Premsyn PMS.

Some over-the-counter pain relievers can also help. These include ibuprofen (brand names: Advil, Motrin, Nuprin), ketoprofen (brand name: Orudis KT), and naproxen (brand name: Aleve).

These medicines can work well for mild or moderate PMS. Talk to your doctor before you try one of these drugs.

All About Periods (for Kids)

A period is when blood comes out through a girl’s vagina. It is a sign that she is getting close to the end of puberty. Puberty is when your body goes from looking like a kid’s into looking more like a grown-up’s.

There is a lot to learn about periods. Here are some common questions that kids have.

When Do Most Girls Get Their Period?

Most girls get their first period when they’re around 12. But getting it any time between age 10 and 15 is OK. Every girl’s body has its own schedule.

How Will I Know My First Period Is Coming?

There are some signs that a girl’s period may start soon. These include:

• She’s worn a bra for a few years.
• She has hair under her arms and in her private parts.
• She has some clear, stringy liquid (called discharge) coming from her vagina.

Why Do Girls Get Periods?

A period happens because of changes in hormones in the body. Hormones give messages to the body. These hormones cause the lining of the uterus (or womb) to build up. This gets the uterus ready for an egg (from the mom) and sperm (from the dad) to attach and grow into a baby. If the woman does not get pregnant, the lining breaks down and bleeds. This same process happens every month. That is why most girls and women get their periods around once a month.

Do Periods Happen Regularly When Menstruation Starts?

For the first few years after a girls starts her period, it may not come regularly. This is normal at first. By about 2–3 years after her first period, a girl’s periods should be coming around once a month.

How Long Do Periods Last?

Periods usually last about 5 days. But a period can be shorter or last longer.

How Often Does a Period Happen?

Periods usually happen about once a month. But some girls get their periods around every 3 weeks. And others only get a period about once every 6 weeks.

Should I Use a Pad, Tampon, or Menstrual Cup?

There are a few ways to deal with period blood. You may need to experiment a bit to find which works best for you. Some girls use only one method and others switch between different methods.

• Most girls use a pad when they first get their period. Pads are made of cotton and come in lots of different sizes and shapes. They have sticky strips that attach to the underwear.
• Many girls prefer to use tampons instead of pads, especially when playing sports or swimming. A tampon is a cotton plug that a girl puts into her vagina. Most tampons come with an applicator that guides the tampon into place. The tampon absorbs the blood. Don’t leave a tampon in for more than 8 hours because this can increase your risk of a serious infection called toxic shock syndrome.
• Some girls prefer a menstrual cup. To use a menstrual cup, a girl inserts it into her vagina. The cup holds the blood until she empties it.

How Much Blood Comes Out?

Although it may look like a lot of blood, a girl usually only loses a few tablespoons of blood for the whole period. Most girls need to change their pad, tampon, or menstrual cup about 3–6 times a day.

Will I Have Periods for the Rest of My Life?

When women are around age 45‒55, they stop having periods (this is called menopause). Women also won’t have a period while they are pregnant.

What Is PMS?

PMS (premenstrual syndrome) is when a girl has emotional and physical symptoms right before her period starts or during the early part of her period. A girl with PMS might:

• be in a bad mood
• feel more sad or worried than usual
• feel bloated (swollen)
• gets pimples

Do All Girls Get Cramps?

Lots of girls have cramps with their period, especially in the first few days. If the cramps are very uncomfortable, a warm heating pad on the belly and medicines can help.

Looking Ahead

Periods are a natural, healthy part of a girl’s life. They shouldn’t get in the way of exercising, having fun, and enjoying life. If you have questions about periods, ask your doctor, a parent, health teacher, school nurse, or older sister.

Premenstrual syndrome (PMS) – Symptoms and causes

Overview

Premenstrual syndrome (PMS) has a wide variety of signs and symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression. It’s estimated that as many as 3 of every 4 menstruating women have experienced some form of premenstrual syndrome.

Symptoms tend to recur in a predictable pattern. But the physical and emotional changes you experience with premenstrual syndrome may vary from just slightly noticeable all the way to intense.

Still, you don’t have to let these problems control your life. Treatments and lifestyle adjustments can help you reduce or manage the signs and symptoms of premenstrual syndrome.

Symptoms

The list of potential signs and symptoms for premenstrual syndrome is long, but most women only experience a few of these problems.

Emotional and behavioral signs and symptoms

• Tension or anxiety
• Depressed mood
• Crying spells
• Mood swings and irritability or anger
• Appetite changes and food cravings
• Trouble falling asleep (insomnia)
• Social withdrawal
• Poor concentration
• Change in libido

Physical signs and symptoms

• Joint or muscle pain
• Headache
• Fatigue
• Weight gain related to fluid retention
• Abdominal bloating
• Breast tenderness
• Acne flare-ups
• Constipation or diarrhea
• Alcohol intolerance

For some, the physical pain and emotional stress are severe enough to affect their daily lives. Regardless of symptom severity, the signs and symptoms generally disappear within four days after the start of the menstrual period for most women.

But a small number of women with premenstrual syndrome have disabling symptoms every month. This form of PMS is called premenstrual dysphoric disorder (PMDD).

PMDD signs and symptoms include depression, mood swings, anger, anxiety, feeling overwhelmed, difficulty concentrating, irritability and tension.

When to see a doctor

If you haven’t been able to manage your premenstrual syndrome with lifestyle changes and the symptoms of PMS are affecting your health and daily activities, see your doctor.

Causes

Exactly what causes premenstrual syndrome is unknown, but several factors may contribute to the condition:

• Cyclic changes in hormones. Signs and symptoms of premenstrual syndrome change with hormonal fluctuations and disappear with pregnancy and menopause.
• Chemical changes in the brain. Fluctuations of serotonin, a brain chemical (neurotransmitter) that’s thought to play a crucial role in mood states, could trigger PMS symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.
• Depression. Some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms

Feb. 07, 2020

Show references

1. Frequently asked questions. Gynecologic problems FAQ057. Premenstrual syndrome. American College of Obstetricians and Gynecologists. https://www. acog.org/Patients/FAQs/Premenstrual-Syndrome-PMS . Accessed Oct. 9, 2017.
2. Yonkers KA, et al. Epidemiology and pathogenesis of premenstrual syndrome and premenstrual dysphoric disorder. https://www.uptodate.com/contents/search. Accessed Dec. 22, 2017.
3. Kellerman RD, et al., eds. Premenstrual syndrome. In: Conn’s Current Therapy: 2018. Philadelphia, Pa.: Saunders Elsevier; 2018. https://www.clinicalkey.com. Accessed Dec. 22, 2017.
4. Ferri FF. Premenstrual syndrome. In: Ferri’s Clinical Advisor 2018. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Sept. 26, 2017.
5. Management of premenstrual syndrome: Green-top guideline No. 48. BJOG: An International Journal of Obstetrics and Gynaecology. 2017;124:e73.
6. Casper RF, et al. Treatment of premenstrual syndrome and premenstrual dysmorphic disorder. https://www.uptodate.com/contents/search. Accessed Dec. 22, 2017.
7. Natural medicines in the clinical management of premenstrual syndrome. Natural Medicines. http://naturalmedicines.therapeuticresearch.com. Accessed Dec. 22, 2017.
8. Chiaramonte D, et al. Integrative women’s health. Medical Clinics of North America. 2017;101:955.
9. Verkaik S, et al. The treatment of premenstrual syndrome with preparations of Vitex agnus castus: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. 2017;217:150.
10. Parazzini F, et al. Magnesium in the gynecological practice: A literature review. Magnesium Research. 2017;30:1.
11. Butler Tobah YS (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 29, 2018.

Premenstrual syndrome (PMS)

Premenstrual Syndrome (PMS) – HealthyWomen

Overview

What Is It?

Premenstrual syndrome (PMS) describes a wide range of severe, recurrent symptoms that occur from several days to two weeks before your period.

Premenstrual syndrome (PMS) describes a wide range of recurrent symptoms that occur from several days to two weeks before your period. PMS affects up to 75 percent of women in their childbearing years, although only 20 percent to 40 percent have difficulties as a result.

The symptoms of PMS can appear any time between puberty and menopause, but the most common age for it to start to become a problem is during the late 20s to early 30s.

Symptoms of PMS may get worse with age and stress, although the underlying causes are not well understood. Even women who have had hysterectomies can have PMS if at least one functional ovary is left. Women who are vulnerable to depressive illness, panic disorder, other psychiatric disorders or chronic medical conditions may also be susceptible to PMS, although these conditions may occur in women without PMS as well. Heredity may also play a role: if your mother or sister suffers from PMS, you may find you experience it, too.

As many as 150 physical and behavioral symptoms have been assigned to PMS, but the number of PMS symptoms that most women experience is much more limited. The most common symptoms include irritability, bloating, mood swings, anxiety, depressed mood, fatigue, appetite changes, water retention and breast tenderness, among others.

Menstrual cramps, or dysmenorrhea, is not considered a PMS symptom, although many women with PMS also experience menstrual cramps.

PMS appears to be caused by a sensitivity to the rising and falling levels of the hormones estrogen and progesterone, which may influence brain chemicals, including serotonin, a substance that has a strong affect on mood. It’s not clear why some women develop PMS or PMDD and others do not, but researchers suspect that some women are more sensitive than others to changes in hormone levels.

Calcium may play a role in PMS, although the reason remains unclear. In one study, women who took 600 mg of calcium twice a day experienced fewer PMS symptoms than women who took a placebo.

Dietary changes and exercise may also help relieve the discomfort of PMS symptoms. When symptoms are severe, serotonergic antidepressant medication may be prescribed. It is thought that increased serotonin reduces PMS symptoms.

One of the most important strategies for coping with premenstrual discomfort is to be aware of any pattern your symptoms follow. The more aware you are of your symptoms—when they start and stop and what works best to relieve them, for example—the better you can develop strategies to recognize and cope with them—whatever they may be.

Premenstrual Dysphoric Disorder

Approximately three to eight percent of women experience premenstrual dysphoric disorder (PMDD), a condition that, like PMS, is associated with the menstrual cycle. The symptoms of PMDD are the same as PMS symptoms, although women with PMDD may experience more dysphoric (depressive) symptoms and more severe symptoms. In fact, to be diagnosed with PMDD, symptoms must be severe enough to disrupt a woman’s daily function.

The most important criteria for a PMDD diagnosis are mood symptoms. Physical symptoms may also be present but aren’t as critical to the diagnosis. The difference between PMDD and mild PMS is like the difference between a mild tension headache and a migraine, experts say.

Women who have a history of depression are at higher risk for PMDD than other women. Treatment for PMDD includes serotonergic antidepressant medications and a particular brand of birth control pills, called Yaz. Yaz contains drospirenone (a progestin) and ethinyl estradiol (a form of estrogen) and has been shown to be clinically effective at treating the emotional and physical symptoms of PMDD, but should only be used to treat PMDD if you choose to use it for birth control because other forms of treatment for PMDD don’t carry the same risks as oral contraceptives. Another form of birth control pill containing drospirenone plus a daily dose of folic acid also is FDA-approved to treat PMDD. It is sold under the brand names Beyaz and Safyral.

Another approach in using birth control pills is to use continuous dosing with no hormone-free interval (for example, Lybrel). This reduced PMS and PMDD symptoms for many women, although findings in multiple studies were not consistent.

Birth control pills containing drospirenone may cause some serious side effects in rare cases, including blood clots in the legs and lungs, so be sure and talk to your health care provider about your risks and benefits. Oral contraceptives are not recommended for women who smoke because of increased cardiovascular risks.

Diagnosis

There is no specific laboratory test to determine if you suffer from PMS, and diagnosis can take some time because symptoms are so varied. But there are certain characteristics that health care professionals consider. To qualify as PMS, symptoms must follow this general pattern:

• They tend to increase in severity as your cycle progresses.
• They improve within a few days of your menstrual period starting.
• They are present for at least two to three consecutive menstrual cycles.

More than 150 physical and behavioral symptoms may be associated with PMS. The most common are irritability and anxiety/tension. Other common symptoms include:

• Sudden mood swings
• Depression
• Headaches
• Joint and muscle aches
• Food cravings
• Fluid retention
• Forgetfulness
• Clumsiness
• Sleep disturbances
• Breast swelling and tenderness

The timing and severity of these symptoms are key to a PMS diagnosis. An average menstrual cycle spans 21 to 35 days. The follicular phase extends from menses to ovulation, and the luteal phase extends from ovulation to menses. PMS occurs during the luteal phase—approximately the last 14 days of your cycle, usually during the five to seven days before you get your period.

A premenstrual symptom chart or checklist (also called a menstrual cycle diary) is the most common method used to evaluate menstrual cycle symptoms. With this tool, you and your health care professional can track the type and severity of your symptoms, as well as when they occur, to identify a pattern that may indicate PMS.

Follow these simple steps to determine if your symptoms fit the PMS pattern:

1. Track your symptoms using the first day of menstrual flow as Day 1. (Note: Don’t be surprised if you do not have any symptoms to record before day 18 or so.)
2. Have a person close to you (your partner, roommate, friend) chart his or her impression of your symptoms, when they occur and their severity.
3. Chart your symptoms for at least three consecutive months to help you and your health care professional identify a pattern that may indicate PMS.
4. Record the date when/if any of the following symptoms occur over two to three consecutive months and note their severity (for example: 1 = mild; 2 = moderate; 3 = severe). Different diaries use different rating systems, with point values to record severity ranging from 1 to 6. You can find an example here.

Physical Symptoms

• Abdominal bloating
• Breast tenderness
• Constipation
• Diarrhea
• Dizziness
• Fatigue
• Headache
• Swelling of hands/feet

Emotional Symptoms

• Anger
• Anxiety
• Depressed mood
• Irritability
• Mood swings
• Tension

Behavioral Symptoms

• Crying spells and tearfulness
• Decreased or increased appetite
• Difficulty concentrating
• Difficulty sleeping
• Forgetfulness
• Hostility

In addition to suggesting that you keep a menstrual cycle diary, your health care professional likely will ask about your personal and family medical history and will give you a physical exam.

Laboratory tests are not routine but may be obtained to rule out other conditions with similar symptoms, such as low blood sugar (hypoglycemia), mania, depression, thyroid disorders, anemia, endometriosis, allergies, fibroids, dysmenorrhea, lupus, endocrine abnormalities, neurological problems such as brain tumors and heart problems.

Menopause and PMS share some of the same symptoms, so depending on your age and health history, your health care professional may want to make sure that you are indeed ovulating and therefore experiencing PMS, not menopausal symptoms.

To do this, you will probably be asked to use an over-the-counter ovulation testing kit. This is a simple test that you can do at home. The results tell you when ovulation is likely.

If you are approaching menopause (the average age is about 51 for U.S. women, but ranges from 42 to 60 years), blood hormone tests may also be used to confirm if you are menopausal. However, a single blood test is not informative because hormone levels change often.

Treatment

Many premenstrual syndrome (PMS) symptoms improve with treatment. Treatment options range from medication therapy to birth control pills to diet modification, including vitamin and mineral supplementation, herbal medicines and exercise.

Antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) are typically recommended to women with severe mood-related symptoms such as anxiety, depression or mood swings.

Overall, common treatment options include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications are used to relieve premenstrual headache and other menstrual-cycle related pain. A variety of NSAIDs are available including over-the-counter ibuprofen products (Motrin) and others or naproxen sodium (Aleve). They usually cost less and have fewer side effects than other treatments. Prescription NSAIDs also are available.

  Note: NSAIDS carry some risks, such as an increased risk of serious cardiovascular (CV) events, including heart attack and stroke. As a result, the FDA has issued a “black box” warning highlighting this risk, as well as the risk of potentially life-threatening stomach bleeding. If you’ve recently had heart surgery, you shouldn’t take NSAIDS. All other women considering NSAIDS to ease PMS or any other condition should discuss these potential risks with their health care professional.

• Contraceptive hormones. Some women with PMS or PMDD experience relief of their symptoms after they start taking birth control pills. (Other women, however, feel worse on birth control pills.) You can take the pill continuously to avoid having a menstrual period, thus preventing the hormonal changes that can lead to PMS/PMDD. The combination birth control pills Yaz (containing 3 mg of drospirenone, a progestin, and 20 mcg ethinyl estradiol, a form of estrogen) and Beyaz and Safyral (containing 3 mg of drospirenone, 20 mcg ethinyl estradiol and a daily dose of folic acid) are FDA approved for the treatment of PMDD. However, these contraceptives should only be used to treat PMDD if you choose to use them for birth control because other forms of treatment don’t carry the same risks as oral contraceptives. Birth control pills containing drospirenone may cause some serious side effects in rare cases, including blood clots in the legs and lungs, so be sure and talk to your health care provider about your risks and benefits. Oral contraceptives are not recommended for women who smoke because of increased cardiovascular risks.
• GnRH agonists (gonadotropin-releasing hormone). These medications include leuprolide (Lupron), among others. They belong to a class of hormones used to temporarily shrink fibroids and relieve endometriosis. They also may be recommended to treat PMS because they “turn off” the menstrual cycle by blocking estrogen production. Side effects may include menopausal symptoms like hot flashes, vaginal dryness and bone loss. That’s why low-dose hormone therapy, a combination of estrogen and progestin hormones, is typically prescribed along with GnRH agonists. Some women may experience a return of their PMS symptoms with the additional hormone therapy. GnRH agonists are usually considered only as a short-term treatment option (given for no longer than six months) because of the increased health risks such as osteoporosis associated with low estrogen levels.
• Antidepressant medications. Antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) are the preferred antidepressants for treating severe PMS and PMDD symptoms, including depression. SSRIs include sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro),and fluoxetine (Prozac, Sarafem). Other types of antidepressants may also be prescribed to treat PMS and PMDD, including venlafaxine (Effexor) and clomipramine (Anafranil). The U.S. Food and Drug Administration approved Zoloft, Paxil and Serafem for treatment of PMDD, but warns that women taking antidepressants should monitor their symptoms closely, with the help of their health care professional, for signs that their condition is getting worse or that they are becoming suicidal, especially when they first start therapy or when their dose is increased or decreased.
• Anti-anxiety medications such as alprazolam (Xanax) are sometimes prescribed when anxiety is the main symptom associated with PMS or PMDD. These drugs can be taken during the 14 days between ovulation and menstruation (the luteal phase) when symptoms occur (rather than daily). Dependence and serious withdrawal reactions can occur with Xanax, so its dosage and discontinuation should be carefully monitored.
• Calcium supplements (1,000 to 1,200 mg daily). Additional calcium in any form may help relieve some PMS symptoms. Low-fat dairy products (milk, yogurt and cheese) are a primary source of calcium, but you can also gain calcium from the following:
  • Tofu and other soy products
  • Rice milk
  • Broccoli
  • Dark greens, like turnip greens
  • Green or red cabbage (raw)
  • Salmon and sardines

  Taking an over-the-counter calcium supplement can also help. In one study, women who took 600 mg of calcium twice a day experienced fewer PMS symptoms than women who took a placebo. But be patient; it may take two to three months to relieve PMS symptoms with calcium supplementation. If symptoms persist, have your vitamin D levels checked or change the type of calcium supplement you’re using. Low levels of vitamin D can affect how the body absorbs calcium, and some generic supplements may not have enough calcium available for absorption.

• Exercise. Regular exercise can also help relieve and possibly prevent PMS symptoms. You will get the greatest benefits if you exercise for at least 30 minutes, at least five days a week. But even taking a 20- to 30-minute walk three times a week can improve your mood.
• Chasteberry. The extract of the fruit of the chasteberry tree is shown to be a safe and effective treatment for PMS. This therapy is used primarily outside the United States. It may be obtained over the counter, but the dose and purity may be uncertain.

In addition, there’s some evidence that some nutritional supplements such as vitamin E, magnesium and vitamin B-6 may help ease symptoms of PMS. Discuss these and other strategies with your health care professional before taking any dietary supplement.

There is no single treatment that works well for every woman who experiences PMS. Typically, it’s wise to try the most conservative treatment options first, which include lifestyle changes such as modifying your diet and exercising more. Discuss your symptoms with your health care professional if strategies you’ve tried don’t work, so he or she can recommend other treatment options.

Prevention

Can premenstrual syndrome (PMS) be prevented? Many women report benefits from a variety of lifestyle change including dietary changes, exercise and stress management. Dietary changes may include:

• Increasing calcium intake.
• Decreasing consumption of refined sugar.
• Decreasing or avoiding caffeine and nicotine, which act as stimulants and can increase tension and anxiety as well as interfere with sleep patterns. For some women, the severity of PMS symptoms increases as caffeine consumption increases.
• Decreasing alcohol consumption, which can act as a depressant. If you experience PMS, you may have an increased sensitivity to alcohol premenstrually.
• Decreasing salt intake and increasing water consumption to avoid water retention and bloating.
• Avoiding sodas, which may contain high levels of caffeine, salt, sugar and/or artificial sweeteners.
• Drinking natural diuretics, such as herbal teas.

Ironically, some PMS symptoms, such as mood swings, irritability, bloating, hunger, carbohydrate cravings and fatigue, may lead you to consume foods that aggravate the condition.

Premenstrually, you may crave either refined sugar (usually combined with chocolate) or fat (combined with salt). Generally, foods high in refined sugars and fat temporarily raise energy levels. But within several hours or less, as your body metabolizes these foods, you may “crash,” meaning you’ll feel worse than before you ate them. Foods high in sugar content can also leave you feeling jittery.

To alleviate mood swings and fatigue, try adding more high-quality, complex carbohydrates to your diet such as:

• Whole grain breads, pastas and cereals
• Potatoes (white or sweet)
• Rice (preferably brown or wild)
• Fresh vegetables, particularly corn and legumes, such as peas, chickpeas and lentils
• Fresh fruits

These complex carbohydrates help keep blood sugar levels even while providing your body with a long-lasting source of energy.

It’s not uncommon for your appetite to increase just before your period begins. To combat the munchies and extra weight gain, try eating smaller, low-fat healthful meals using the food choices listed above.

Make sure you include adequate calcium in your diet; calcium may help prevent irritability, anxiety and other PMS symptoms. Good sources of calcium include:

• Low-fat milk and milk products like yogurt, ice cream and cheese
• Broccoli
• Dark greens (like turnip greens)
• Green or red cabbage (raw)
• Cooked collards
• Salmon and sardines
• Soy products, such as tofu and soy milk
• Calcium-fortified orange and grapefruit juices

Another good way to prevent PMS symptoms is through regular exercise in the form of aerobic activities such as brisk walking, jogging, biking or swimming. You will get the greatest benefits from exercise if you do it for at least 30 minutes, five or more days a week. But even taking a 20- to 30-minute walk three times a week can:

• Increase endorphin and serotonin production, brain chemicals that may help decrease pain and discomfort and improve mood, respectively
• Decrease stress and anxiety
• Increase REM sleep

Other lifestyle changes that will help you control PMS include:

• Sleeping consistent hours
• Establishing a bedtime routine to help cue body and mind for sleeping
• Keeping a PMS symptom checklist, also called a menstrual cycle diary, to identify when symptoms and which symptoms occur so you can be prepared for them

Facts to Know

1. An estimated 75 percent of women of childbearing age experience premenstrual symptoms ranging from very mild to very severe.
2. Approximately 3 to 8 percent of women experience premenstrual symptoms severe enough to disrupt their daily function and meet criteria for premenstrual dysphoric disorder (PMDD)––a severe form of PMS.
3. Taking additional calcium in any form may help improve or even prevent PMS symptoms. Ideally, increase daily amounts of low-fat dairy products and other calcium-containing foods to reach the 1,000 to 1,200 mg of calcium daily health care professionals recommend. If you have trouble reaching this goal from your diet alone, consider using over-the counter calcium supplements.
4. Symptoms of PMS may get worse with age.
5. If you experience PMS, you may experience an increased sensitivity to alcohol premenstrually.
6. Some evidence suggests that women who are vulnerable to depressive illness, panic disorder or other psychiatric or chronic medical disorders may be particularly susceptible to PMS.
7. Strategies for PMS symptom relief include medication, dietary changes, exercise and stress management.
8. Dietary changes to relieve PMS symptoms include increasing daily amounts of dietary or supplemental calcium, drinking more water and adding more complex carbohydrates (fruits, vegetables and grains) to your meals. Decreasing foods in your diet that contain refined sugar, limiting or avoiding caffeine and nicotine, decreasing alcohol consumption, decreasing salt intake and avoiding sodas may also help.
9. Some of the PMS symptoms you may experience, such as mood swings, irritability, bloating, hunger, carbohydrate cravings and fatigue, may lead you to consume high-fat foods and/or foods high in refined sugar, which actually aggravate these symptoms. Try to avoid them.
10. Even women who have had hysterectomies can have symptoms of PMS if at least one functional ovary is left intact following the hysterectomy.

Questions to Ask

Review the following Questions to Ask about premenstrual syndrome (PMS) so you’re prepared to discuss this important health issue with your health care professional.

1. What causes PMS?
2. Are my symptoms characteristic of PMS?
3. What other illnesses could be causing these symptoms?
4. Which tests, if any, should I have to rule out other illnesses?
5. How is PMS treated?
6. What treatment may work best for me?
7. I’ve heard that not getting enough calcium can cause PMS. How can I add calcium to my diet?
8. What’s premenstrual dysphoric disorder (PMDD)?
9. How do you treat PMDD?

Key Q&A

1. What exactly is premenstrual syndrome (PMS)?
   There are more than 150 documented symptoms of PMS, but the number of symptoms seen in the vast majority of patients is much more limited. Some of the most common PMS symptoms include bloating, fatigue, sudden mood swings, irritability, anxiety, depression, weight gain, headaches, joint and muscle aches, food cravings and fluid retention. To be considered PMS symptoms, they must occur exclusively in the last 14 days of your menstrual cycle (usually about five to seven days before your period begins). True PMS symptoms tend to increase in severity as the cycle progresses and are relieved within a few days after the start of the menstrual flow. Cramps are not considered a symptom of PMS, but they are common in women with PMS.
2. What causes PMS?
   PMS appears to be caused by a sensitivity to the normal rising and falling levels of the hormones estrogen and progesterone, which may influence brain chemicals, including serotonin, a substance that has a strong affect on mood. It’s not clear why some women develop PMS or PMDD and others do not, but researchers suspect that some women are more sensitive than others to changes in hormone levels.
3. How is PMS diagnosed?
   There is no single laboratory test for PMS, but one of the most common ways to diagnosis PMS is by keeping a daily checklist, chart or “menstrual cycle diary” that tracks when your premenstrual symptoms occur for a few consecutive months. Your health care professional should rule out other disorders or diseases that mimic or are identical to the symptoms caused by PMS before diagnosing you with the condition. Other conditions include but are not limited to thyroid disorders, depression, endocrine abnormalities, menopause, heart problems, allergies and low blood sugar. Laboratory tests, personal and family medical histories and a physical exam are part of the diagnostic process.
4. Is PMS treatable?
   Yes! Many women experience some relief from PMS symptoms if they make diet and lifestyle changes, particularly increasing consumption of calcium, complex carbohydrates (fruits, vegetables, grains and beans) and water, and decreasing caffeine, alcohol, salt and refined sugar intake. Regular exercise and sleep may also help relieve symptoms. Certain medications can provide relief.
5. When does PMS typically appear?
   PMS symptoms can appear any time between puberty and menopause, though the most common age for PMS to start to become a problem is during your late 20s to mid-30s.
6. Will my PMS symptoms get better as I age?
   Probably not until you reach menopause. In some women, symptoms of PMS worsen with age and stress. Even women who have had hysterectomies can have PMS if at least one functional ovary is left intact following the hysterectomy. Once you reach menopause, your PMS symptoms will end with the end of menstruation.
7. If I regularly take the recommended steps to relieve my PMS symptoms, how long before I may see results?
   It may take two to three months to experience relief from PMS symptoms. If you don’t see any improvements by then, check with your health care professional for a new action plan.
8. Are menstrual cramps a symptom of PMS?
   Cramps are not considered a symptom of PMS, although they may occur in women who have PMS. Called dysmenorrhea, cramps typically begin just before (24 to 48 hours) the onset of menstruation and disappear by the end of flow.

Lifestyle Tips

1. Lifestyle changes for PMS sufferers
   Some of the lifestyles changes recommended to treat premenstrual syndrome (PMS) may also be useful in preventing symptoms. Perform aerobic activity such as brisk walking, jogging, biking or swimming for a minimum of two hours and 30 minutes of moderate-intensity exercise, or one hour and 15 minutes of vigorous-intensity exercise, or a combination of moderate-intensity and vigorous-intensity activity. Couple this with muscle strengthening exercise at least two days a week. Some women benefit from eating a balanced diet (with increased whole grains, vegetables, fruit, and decreased or no salt, sugar, alcohol and caffeine). It’s also important to manage stress and get adequate rest; the body may have different sleep requirements at different times during the menstrual cycle.
2. Eating right to fight PMS
   To reduce your PMS symptoms, spread your normal caloric intake over three small meals and three small snacks per day, and avoid going for long periods of time without eating. Avoid or wean yourself off caffeine. Caffeine can worsen breast tenderness, and many women report that irritability and headaches decrease when they cut their caffeine intake. Reducing salt intake can relieve fluid retention. Snack suggestions: Plain yogurt; unsalted nuts, seeds and popcorn; whole-wheat bread with peanut butter; pumpkin or banana bread; graham crackers; unsalted whole-grain crackers; bran or oatmeal muffins; raw vegetables; and raw or dried fruits.
3. Calcium can help alleviate PMS symptoms
   If you suffer from the physical and psychological symptoms typical in premenstrual syndrome (PMS), calcium may help solve your problem. In one study, women who took 600 mg of calcium twice a day experienced fewer PMS symptoms than women who took a placebo. Calcium can be obtained through the diet or in the form of nutritional supplements or antacids. Remember to talk to your health care professional before taking calcium supplements.
4. Medications for PMS
   If a healthy diet, regular exercise and calcium supplements fail to improve mood swings or other emotional symptoms of PMS, you may want to talk to your health care professional about a serotonin reuptake inhibitor (SSRI) antidepressant medication. Other prescription medications sometimes prescribed for severe PMS include gonadotropin-releasing hormone (GnRH) agonist treatments that suppress estrogen production and oral contraceptives. A type of “combination” oral contraceptive containing drospirenone, a progestin, and ethinyl estradiol, a form of estrogen, is FDA approved for both the prevention of pregnancy and for the emotional and physical symptoms associated with PMDD. However, these contraceptives (Yaz, Beyaz and Safyral) should only be used to treat PMDD if you choose to use them for birth control because other forms of treatment don’t carry the same risks as oral contraceptives. Other oral contraceptives, such as Lybrel, can be taken continuously with no inactive interval to relieve PMS or PMDD. Oral contraceptives are not recommended for women who smoke because of increased cardiovascular risks. Be sure to ask your health care professional about short- and long-term side effects of any medications recommended to relieve symptoms of PMS and PMDD.
5. Is it PMS or PMDD?
   If your premenstrual symptoms are bothersome, you may have PMS. If the symptoms are primarily emotional or behavioral and are severe enough to interfere significantly with work or relationships, you may have a more serious form of PMS, premenstrual dysphoric disorder (PMDD), which affects about 3 to 8 percent of women of childbearing age. PMDD symptoms can include a markedly depressed mood, severe anxiety or tension and wild mood shifts, as well as significant physical symptoms. However, severe mood-related symptoms are key to PMDD. If you suspect you have PMDD or PMS, consult your health care professional.

Organizations and Support

For information and support on coping with Premenstrual Syndrome, please see the recommended organizations, books and Spanish-language resources listed below.

American College of Obstetricians and Gynecologists (ACOG)
Website: http://www.acog.org
Address: 409 12th Street, SW
P.O. Box 96920
Washington, DC 20090
Phone: 202-638-5577
Email: [email protected]

MGH Center for Women’s Mental Health
Website: http://www.womensmentalhealth.org
Address: Perinatal and Reproductive Psychiatry Program Simches Research Builiding
185 Cambridge St Suite 2200
Boston, MA 02114
Phone: 617-724-7792

National Family Planning and Reproductive Health Association (NFPRHA)
Website: http://www.nfprha.org
Address: 1627 K Street, NW, 12th Floor
Washington, DC 20006
Phone: 202-293-3114
Email: [email protected]

Books

A Gynecologist’s Second Opinion
by William H. Parker and Rachel L. Parker

Bitchin’ in the Kitchen: The PMS Survival Cookbook
by Jennifer Evans

Curing PMS Naturally with Chinese Medicine
by Bob Flaws

Natural Medicine for PMS
by Deborah R. Mitchell

Once a Month: Understanding and Treating PMS
by Katharina Dalton

PMS & Perimenopause Sourcebook: A Guide to the Emotional, Mental, and Physical Patterns of a Woman’s Life
by Lori Futterman and John E. Jones

PMS Relief: Natural Approaches to Treating Symptoms
by J. Marshall

PMS: Women Tell Women How to Control Premenstrual Syndrome
by Stephanie Degraff Bender and Kathleen Kelleher

Self-Help for Premenstrual Syndrome
by Marla Ahlgrimm R.Ph.

SOS for PMS: Whole Food Solutions for Premenstrual Syndrome
by Lissa Deangelis and Molly Siple

Spanish-language resources

Medline Plus: Premenstrual Syndrome
Website: http://www.nlm.nih.gov/medlineplus/spanish/premenstrualsyndrome.html
Address: Customer Service
8600 Rockville Pike
Bethesda, MD 20894
Email: [email protected]

Womenshealth.gov
Website: http://www.womenshealth.gov/espanol/preguntas/pms.cfm
Hotline: 1-800-994-9662

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

Key Facts

• PMS symptoms usually begin the week before a menstrual period and get better or go away completely when a women’s period starts
• Common symptoms of PMS: mood swings, breast soreness, bloating, acne, cravings for certain foods, and fatigue.
• PMS is treated with lifestyle changes and sometimes medication.
• PMDD is a severe and chronic form of PMS. Symptoms are usually treated with medication.

PMS stands for Premenstrual Syndrome; “pre” means “before” and “menstrual” refers to the menstrual cycle or periods. Not all girls will get PMS. Most girls and women with PMS have symptoms during the week before their period that lessen or disappear within 1-2 days after their period starts. Symptoms can usually be treated with lifestyle changes such as exercise and relaxation therapy and over-the-counter medicine. If these aren’t effective, prescription medicines are sometimes prescribed.

PMDD stands for Premenstrual Dysphoric Disorder. This diagnosis is reserved for young and adult women who have: five or more of the most common PMS symptoms during the week before their period, for at least two menstrual cycles in a row, and symptoms are not due to a medical condition such as thyroid disease. Symptoms such as mood swings, irritability, depression and fatigue are usually so severe that the young/adult woman misses school, work and/or avoids her regular social activities.

How do I know if I have PMS symptoms?

PMS symptoms usually occur 5-7 days before a girl/woman’s menstrual period. There are actually a total of 150 known symptoms of PMS. The most common symptoms include: mood swings, breast soreness, bloating, acne, cravings for certain foods, increased hunger and thirst, and fatigue. Other symptoms may include constipation or diarrhea, irritability, and feeling blue or down in the dumps. If you have any of these symptoms and they happen during the week before your period starts and go away when your period arrives or a few days later, you may have PMS. If you feel blue or down in the dumps and these feelings last longer than the week before your period, it’s probably not related to PMS. In this situation, it’s particularly important to ask your primary care provider if you should talk to a counselor or therapist.

Since there are so many possible symptoms of PMS, it’s a good idea to keep track of them. Remember to note if the symptoms are mild, moderate, or severe. Use a period and symptom tracker for 2-3 months and then bring it to your next medical appointment. A record of your symptoms can help your health care provider figure out the best treatment choices for you.

My Monthly Period & Symptom Tracker

My Monthly Period & Symptom Tracker is an easy way to keep track of your menstrual flow, and it’s also a way to keep track of cramps, and/or PMS and period symptoms (if you have them) each month There are other ways of tracking your periods and symptoms including apps available for iPhones and Android phones – talk to your HCP to determine what method will best work for you.

• Review the sample Monthly Period & Symptom Tracker.
• Print out copies of My Monthly Period & Symptom Tracker.
• Put a check mark in the appropriate box (or boxes) for each day of the month. If you don’t have any flow or any symptoms on any given day, leave the box empty. Refer to the Blood Flow Key at the bottom for “Flow” definitions.
• The dates at the top are the same as the dates in one month. Each month has 30 or 31 days (except for February which has 28 or 29 depending unless it is a leap year).
• Remember to bring My Monthly Period & Symptom Tracker with you to your medical appointments.

Sample Monthly Period and Symptom Tracker

My Monthly Period and Symptom Tracker

What causes PMS?

Scientists are still trying to figure out what causes PMS. We know that during the second half of the menstrual cycle, progesterone (female hormone) levels increase. Then, just before the period comes, progesterone and estrogen (another female hormone) levels drop. It is believed that changes in hormone levels result in PMS symptoms. Other factors may have an effect on PMS symptoms; for example, you may notice that your symptoms are better if you get plenty of sleep and exercise regularly. Although PMS can be frustrating, there are things you can do that may help relieve your symptoms.

Are there any tests to check for PMS?

There are no specific tests such as a blood test to diagnose PMS. The diagnosis is based on specific symptoms. Your health care provider (HCP)will likely ask you a lot of questions. Some questions will be about your period and when you have symptoms, how long they last, etc. and if your symptoms get better or disappear when your period starts. Your HCP will also ask about what medicines you take including any over-the-counter medicine, vitamins and dietary supplements. They  may order tests to make sure your symptoms are not caused by another condition such as a problem with your thyroid gland. Also, your HCP may ask you if you have ever been treated for a mood or anxiety disorder, substance abuse, headaches, chronic fatigue or other medical conditions that can sometimes get worse a few days before a  menstrual period.

Is there anything I can do to treat my PMS symptoms?

Nutrition and lifestyle changes are a first step. The following suggestions are healthy recommendations for everyone and are particularly helpful for young women with PMS symptoms, according to research.

Nutrition Changes:

• Eat whole grains that are high in fiber (such as whole grain breads, whole wheat pasta, and high fiber cereals instead of white bread, white pasta, and sugary cereals). Whole grains help to keep blood sugar levels more stable compared to refined grains such as white bread, which could keep cravings under control and prevent mood changes associated with PMS.
• Cut back on sugar and fat. Even though your body may be craving sweets or fast foods that are high in fat, try to limit these foods since they may add to your PMS symptoms such as bloating.
• Limit foods high in salt (sodium) for the few days before your period. For example, avoid: canned soups, Chinese food, hotdogs, chips, and pizza which are very high in sodium. Cutting down on sodium may help to control bloating by lowering the amount of fluid your body retains.
• Keep hydrated. Drink plenty of water to reduce bloating and help with digestion.
• Cut back on caffeine. Reducing the amount of caffeine you eat and drink (soda, coffee drinks, and chocolate) may help you feel less tense and may also ease irritability and breast soreness.
• Try eating up to 6 small meals a day instead of 3 large ones and include a balance of foods and nutrients (lean protein, whole grain carbohydrates, fruits/veggies, and healthy fats such as olive oil or avocado) at each small meal. This will help keep your blood sugar levels even, which will give you energy that lasts.
• Don’t forget calcium! Research studies have shown that getting 1300 mg of calcium per day may help with PMS symptoms such as mood swings, headaches, and irritability. This means you should eat or drink three to four servings of high calcium foods (such as milk, Calcium fortified OJ, or soy milk) each day or take calcium supplements.

Lifestyle Changes:

• Fit in exercise. Do aerobic exercise (such as running, dancing, or jump roping) for 30-60 minutes a day, 4 to 6 times a week.
• Catch your ZZZ’s. If you’re a teen, you need about 9 hours of sleep each night.
• Try to maintain a regular schedule. This includes meals, exercise, and bedtime.
• Keep stress to a minimum. If possible, try to schedule events that you think could be stressful during the week after your period.
• Avoid alcohol. Drinking alcohol before your period can make you feel more depressed.

Are there medications that might help?

If your symptoms don’t improve with a few nutrition and lifestyle changes, talk with your health care provider (HCP). They may be able to prescribe medicine that will help lessen or get rid of your discomforts. There are many different medicines that are currently used to treat PMS symptoms. The most commonly prescribed are oral contraceptives (birth control pills) which prevent ovulation and keep hormone levels even. Most pills (particularly those that are low in progestin or contain drospirenone) can improve symptoms. Sometimes symptoms can improve even more if the pill is taken continuously (one active pill every day and no placebo pills). Other medications such as ibuprofen or naproxen sodium  can help to relieve lower back discomfort and headaches.  A mild diuretic such as Spironolactone can lessen bloating and mood changes. If depression is a significant issue, your health care provider may prescribe antidepressants such as Fluoxetine, Sertraline, or other SSRI medicines either for the 7 days before your period or daily.

Are there vitamins or minerals that will improve my symptoms?

Although more research studies are needed, there are certain vitamins and minerals that may help PMS symptoms. Several research studies show that calcium can significantly decrease many of the symptoms associated with PMS. Make sure that you are getting the recommended 1300 mg/day from calcium-rich foods or drinks or from supplements. Other supplements that could help with PMS symptoms are magnesium (400 mg/day), vitamin B6 (100 mg/day), and vitamin E (400 IU/day), but more research is needed. Check with your health care provider about whether you should try them and how much you should take because taking high doses of supplements can have unpleasant or dangerous side effects. For example, high doses of magnesium may cause diarrhea in some people.

Sometimes other medical conditions can mimic or act like PMS symptoms, so it’s important to keep your health care provider up-to-date with any health issues you are having. If your PMS symptoms are so severe that you feel very depressed, talk with a parent, guardian, or trusted adult, and make an appointment with your health care provider as soon as possible.

Premenstrual syndrome: Overview – InformedHealth.org

Introduction

In the days leading up to their period, many women experience abdominal pain or a headache, are sad and irritable or feel bloated and generally uncomfortable. The medical term for this is “premenstrual syndrome” (PMS), also known as “premenstrual tension” (PMT). PMS symptoms are usually not very severe, and most women cope well with them. But in some women it is so bad that they are unable to go about their everyday lives during that time. Various treatments and measures can help to relieve PMS.

Symptoms

Premenstrual syndrome is a set of physical and psychological symptoms that start anywhere from a few days to two weeks before a woman gets her monthly period (menstruation).

Many women experience breast tenderness and abdominal pain, for instance. Other symptoms include headaches, back pain and joint or muscle ache. Water retention, sleep problems or digestion problems, skin blemishes and food cravings may occur too.

Women who have PMS often feel exhausted, insecure, down, listless, irritable or angry in the days leading up to their period. Some have problems concentrating and experience mood swings. They might feel like they are losing control over their body and emotions. Severe PMS can really affect your everyday life and your relationships with friends, family, partners and colleagues.

PMS that is so bad that it significantly affects mental health – leading to things like depression or anxiety – is known as premenstrual dysphoric disorder (PMDD).

Causes

The causes of PMS are not completely clear. But it is thought that hormonal fluctuations during a woman’s monthly cycle play a role. Although women who have PMS don’t necessarily have abnormal hormone levels, they might react particularly sensitively to the substances that are produced when progesterone is broken down. This hormone is mainly released in the second half of the menstrual cycle, before the woman’s period starts.

It is also thought that progesterone might affect neurotransmitters (chemical messengers) in the brain. Serotonin apparently plays an important role here. Genes and environmental factors probably affect the likelihood of getting PMS too.

Prevalence

Most girls and women have mild PMS every now and then in the time leading up to their period.  But it hardly affects their lives.

About 20 to 40% of all girls and women have several more severe PMS-related problems that clearly affect them.

In 3 to 8% of them, these problems – particularly the psychological problems – are so bad that they are unable to go about their everyday lives. The medical term for this is premenstrual dysphoric disorder (PMDD).

Outlook

Women get PMS in the second half of their monthly cycle, after ovulation. During this phase of the cycle their body produces more of the hormone progesterone, and less of the female sex hormone estrogen (oestrogen).

When women get their period and a new cycle begins, their PMS starts getting better. It goes away completely by the end of the period at the latest, and can only start again after the next ovulation.

Some women have PMS during some cycles, but not during others. The severity of PMS can vary greatly from month to month too, and change over the years. But it isn’t possible to predict how PMS will develop over time. The only thing that is certain is that it will stop after menopause.

Diagnosis

To be sure that it is PMS, the doctor will ask exactly what symptoms you have and when you have them. He or she will also want to rule out medical conditions that can cause similar symptoms, such as depression, thyroid problems or irritable bowel syndrome.

A diary can help you keep track of the PMS symptoms you experience during the monthly cycle. Ideally, all of the symptoms and related problems should be recorded for at least two to three months.

Treatment

There isn’t much good research on what can help reduce PMS. So it isn’t clear how effective many of the PMS treatments are.

Girls and women with PMS often try out different things to reduce their symptoms. For instance, some women with mild PMS try out relaxation techniques, acupuncture, getting more exercise, drinking less alcohol and coffee, or eating less salt. Others use herbal products and dietary supplements such as chaste tree extracts (Vitex agnus castus), St. John’s wort, calcium or pyridoxine (vitamin B6).

More severe PMS can be treated with a number of medications. But many of these medications haven’t been approved for the treatment of PMS, and they can have side effects:

• Hormone medications like the birth control pill or hormone patches affect women’s hormone levels and lead to an improvement in PMS or PMDD.

• Antidepressants: SSRIs (selective serotonin reuptake inhibitors) can help reduce severe psychological problems caused by PMS or PMDD.

• Painkillers can effectively relieve severe period pain and are usually well tolerated. There is very little research on whether they also help in PMS, though.

• Women who have problems with PMS-related water retention can take diuretics (water pills).

If PMS causes psychological problems, cognitive behavioral therapy (CBT) is an option. But it isn’t clear whether it helps in PMS.

Everyday life

Many women who have PMS try to take it easy on the days leading up to their period, and make a conscious effort to take more breaks and relax more – for instance, by having a hot bath, going on a walk, or spending a quiet evening curled up on the sofa with a book or watching TV.

Some find that talking to their partner or family about their PMS leads to more understanding, consideration and support.

But they might be afraid to say that they have PMS in case people stop taking them seriously when they are irritable or angry, and put it down to PMS instead. Some also have a hard time because of prejudiced views that women are irrational and unpredictable at certain times of the month due to their hormones.

Sources

• Beckermann MJ. Das prämenstruelle Syndrom – ein Konstrukt? In: Beckermann MJ, Perl FM (Ed). Frauen-Heilkunde und Geburts-Hilfe. Basel: Schwabe; 2004. p. 502-527.

• Kwan I, Onwude JL. Premenstrual syndrome. BMJ Clin Evid 2009.

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

What Is PMS? 16 Symptoms
– Casco Cup

Premenstrual syndrome or PMS affects almost everyone who has a period. But PMS’s meaning varies between women and can even differ month to month. If you’re like us, you want a more definitive answer to the age-old question, what is PMS? Lucky for you, we did some research so you don’t have to.

At the most basic level, premenstrual syndrome is a combination of physical and behavioral changes that forecast that your period is on its way. Here are a few symptoms to look for – and some common ways women may find some relief.

Disclaimer: Not sure what to do with a major case of PMS? Please contact your gynecologist. We are not doctors, so the following should not be read as medical advice.

PMS Meaning, Explained

PMS, the abbreviation for Premenstrual Syndrome, can mean physical, behavioral or emotional changes that accompany your body’s hormonal fluctuations before a period. Typically, they occur a week before your period and can range in severity from painful enough to merit a sick day from school or work or so mild you barely even notice them.

According to a study published by the University of Southern California school of medicine, up to 90% of women experience these symptoms on a regular basis. Some women are more genetically predisposed to experience them than others.

Depending on the research you consider, between 2 and 10 percent of people report debilitating symptoms. Extreme versions of this condition may be diagnosed as premenstrual dysphoric disorder (PMDD), which may require medical treatment.

16 Common PMS Symptoms

All ladies know that just because premenstrual syndrome is common doesn’t mean that it’s easy. One study found that women who were diagnosed with it experienced over $4,000 in indirect costs annually from challenges that arise from it. In other words, PMS’s meaning for many women may mean a distraction from work, school and other activities that define her life.

This is because PMS symptoms can be wide-ranging, uncomfortable or painful and several distracting. These indicators can be divided into two categories: physical and emotional. Keep in mind that there are approximately 200 PMS symptoms, according to some research. Your experiences may be different than those listed. If you’re considered, please see a doctor.

Physical PMS Symptoms:

These may include (but are not limited to):

• Fatigue
• Tender breasts
• Bloating or weight gain
• Acne
• Food cravings
• Diarrhea or constipation
• Headaches
• Aches and pains
• Gassiness
• Vaginal pH changes

Emotional Indicators

PMS’ impacts are not only physical. In fact, some research has linked PMS and depression: In one study, 26 percent of women with depression showed signs of premenstrual syndrome compared to 9% of non-depressed subjects. Emotional symptoms may include:

• Irritability or mood swings
• Depression and crying
• Change in sex drive
• Anxiety
• Feelings of isolation
• Insomnia or change in sleep patterns
• Difficulty concentrating or remembering

If you are struggling with any of these symptoms, please contact your doctor for more information.

What Causes PMS?

No one knows exactly what causes these symptoms. We do know that they are connected to neurotransmitters and neurohormones and that their severity may be genetic.

Why would premenstrual syndrome affect your mood in the first place? Some say that it is connected to serotonin levels — the chemical i.e. a neurotransmitter that may affect your mood – levels in the brain. This could be the reason why PMS symptoms may include depression or anxiety.

Other facts about your menstrual cycle:

• Hormones can affect sleep patterns, which can contribute to insomnia.
• Shifting estrogen levels may contribute to headaches.
• Prolactin, a hormone associated with breastfeeding, may cause swelling and tender breasts.

Keep in mind that we are not doctors. This information is based on research, but any serious medical questions should be addressed to your gynecologist.

Fun Fact: Certain symptoms are more associated with phases in the menstrual cycle, such as the follicular phase.

When Does PMS Start?

Premenstrual Syndrome typically begins between 11 and 5 days before your period. Usually, it goes away within a few days of menstruation. When does PMS start? Technically it begins in the luteal phase of the menstrual cycle. This is the time between ovulation and the start of your period. The luteal phase either cumulates in pregnancy or a period. Then, your body starts the whole process over again.

During the luteal phase, a woman’s body produces large amounts of progesterone, then the production of this hormone drops off. The luteal phase lasts between 9 and 16 days, though the average length is 14 days, according to research.

How Long Does PMS Last?

OK great, now I understand why I’m bloated and in a terrible mood. But how long can I expect to feel this way?

Usually, PMS symptoms can begin as early as 14 days before your period, though they typically disappear within a few days of menstruation. They may, however, last up to day 7 of menstruation (yikes). In typical cases, symptoms may begin as early as 11 days to 5 days prior to a period and stop when the period starts. If you are concerned about the length or severity of symptoms, the best course of action is to see your doctor.

How to Relieve Premenstrual Syndrome

You might be wondering, “Great, I can answer, what is PMS, but all I want to do is relieve my symptoms?” Excellent question. Though there is no “cure” for these symptoms, there are many ways to mitigate their severity. Here are a few ways that some women manage their time of the month:

• Eating healthfully
• Limiting caffeine
• Increasing exercise
• Limiting stress
• Stop smoking

Does Caffeine Affect PMS?

Research is unclear on whether there is a correlation between caffeine consumption and the physical and behavioral symptoms associated with menstruation. The American College of Obstetricians and Gynecologists suggests that women who experience premenstrual syndrome avoid caffeine. This may be because women with severe cases are more likely to consume larger amounts of caffeine.

This may be a chicken or the egg situation: Women who suffer from fatigue prior to their period may be more inclined to consume caffeine, for example. Similarly, people who consume caffeine are more likely to smoke, which may also contribute to PMS symptoms.

Smoking and Premenstrual Syndrome

Research on the connection between smoking and those dreaded period indicators is more clear. According to research, women between the ages of 27 and 44 are two times more likely to experience PMS symptoms if they smoke. This is because smoking may affect hormone levels, including progesterone and estrogen. It may also lower Vitamin D levels.

PMS symptoms linked to smoking may include acne, bloating, aches, and tender breasts.

Eating Well and Exercising May Reduce Premenstrual Syndrome

Eating a healthy diet and going light on the junk food may actually help you when Aunt Flo comes around, according to research. One study of adolescent girls uncovered a correlation between menstrual cramps and junk food consumption. More generally, it links PMS symptoms to a lack of exercise.

Other studies support this research: Considering 40 non-athletic girls between the ages of 18 and 25, other research found that eight weeks of aerobic exercise reduced the physical and psychological symptoms commonly connected to menstruation.

Cramps are also more common around menarche, which is a girl’s first period.

Medications for Reducing Physical Discomfort

For people who deal with breast discomfort, cramping, aches, and pains, non-steroidal anti-inflammatory drugs (NSAIDs) may offer relief. These may include over-the-counter medications such as ibuprofen, Advil, Midol, Motrin, or Aleve. Check with your doctor — especially if you’re considering long-term use or are using other medications.

Hormonal Birth Control May Help with PMS

In some cases, especially ones with extreme symptoms, hormonal birth control may help. In other words, a contraceptive device such as a hormonal IUD or the pill may stop ovulation, thereby reducing PMS symptoms. If you’re curious about either of these methods, please speak with a gynecologist to learn about your options.

Supplements that Some Women Find Helpful

Sometimes, diet and exercise (and avoiding cigarettes, of course) may not be enough. Some people choose to take supplements to mitigate PMS symptoms. Keep in mind that many supplements and supportive strategies for dealing with your period are experimental. This means that choosing to take a dietary supplement is a personal choice that you should make with a doctor.

Calcium for PMS

According to research, women who suffer from premenstrual syndrome may not consume enough calcium. One study gave women 500 mg of calcium every day for 2 months. It concluded that by the second menstrual cycle phase, the calcium reduced water retention, sleep pattern changes, and emotional changes such as anxiety and depression.

Another way to benefit from calcium is to eat calcium-rich food including:

• Yogurt
• Seeds (think: sesame, chia and poppy seeds)
• Salmon and sardines
• Legumes (beans and lentils especially)
• Leafy greens (collard greens and spinach)
• Cheese

As always, talk to your physician before you begin consuming supplements.

Vitamin B-6

One of the potential benefits of Vitamin B may be a reduction in PMS symptoms – especially those that affect your psychological wellbeing, according to research. In addition to a water-soluble supplement, you may also get your daily Vitamin B-6 from:

• Salmon and other fish
• Potatoes
• Organ meats (think: liver)
• Chickpeas

If you’re taking a supplement, follow the instruction on the label and consult with your doctor.

Evening Primrose Oil

Though there is no research on the effects of evening primrose oil on your period, some people take it to ease their side-effects. These may include breast tenderness, bloating, and psychological side-effects like depression and anxiety.

The research and regulations surrounding herbal supplements compared to pharmaceuticals are limited. However, one study found that people who had taken evening primrose oil capsules experienced an improvement in neuropathy test scores over six months.

Chasteberry for PMS

The fruit of the Chaste tree and native to the Mediterranean and Central Asia, Chasteberry has long been a supplement for PMS symptoms. Specifically, a scientific review of various studies on the herbal remedy found that it helps with physical troubles such as bloating, headaches and breast tenderness. Research even found that it was better at mitigating these symptoms than antidepressant Prozac, though it was not superior at assuaging mood swings than the pharmaceutical.

Magnesium Supplements

Another common PMS supplement sometimes combined with vitamin B-6 is magnesium. Similar to calcium, some people who experience discomfort or emotional changes around their period may have low levels of magnesium.

One study uncovered that a Vitamin B-6 and magnesium supplement had the highest effect on decreasing PMS symptoms. This was in comparison to a pure magnesium supplement or placebo.

Managing PMS Symptoms in 2021

Let’s face it: Most of us still deal with premenstrual syndrome on a routine basis. And though there is no “cure” for these irksome, distracting and sometimes painful side-effects, there is a lot we can do about it.

For starters, some research finds that maintaining a healthy lifestyle, which means exercising regularly and avoiding junk food and smoking, can make a huge difference. Similarly, there are all-natural supplements and pharmaceuticals that may help relieve certain aches and pains. Another way to potentially mitigate symptoms is to plan for them. That may mean using a period tracker app.

Of course, the best thing to do is to contact your doctor and keep them informed of what you’re experiencing.

When it comes to PMS it’s all about awareness: Understanding what it is, what can help alleviate it, and knowing that you’re not alone when it comes to struggling with your period.

90,000 The first menstruation in girls: when they start, signs of what to do

Date of last update: 04/30/2021

Average Read Time: 6 minutes

Contents:

Why do menstruation appear?
Harbingers of the first menstruation
At what age do girls begin their periods?
What are their first periods?

“I’m probably dying,” thought the heroine of the novel “The Thorn Birds” when she had her period.She knew nothing about cyclic menstrual bleeding, and her anxiety seemed justified to her. We want to tell you everything in advance so that the first menstruation does not become a surprise and cause for alarm.

Cyclic uterine bleeding is absolutely normal for every woman, indicating her ability to conceive.

Doctors call the first menstrual period in the girl’s life “menarche” – from the Greek words “month” and “beginning” ¹ . Theoretically, from now on, your body is ready for pregnancy ¹ .However, in fact, it is still too early to become a mother: ahead is the path of physical and psychological formation of you as a woman.

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Why do menstruation appear?

The causes of menarche lie in hormonal changes that occur in the body during puberty ^1.2 .

The brain has a small, but very important gland – the hypothalamus, which controls the work of the entire endocrine system ^1.2 . When a girl enters adolescence, her hypothalamus releases releasing factors into the bloodstream (from the English.Release) and thus starts the process of puberty ^1.2 .

Releasing factors act on another gland of the brain – the pituitary gland, which, in turn, begins to synthesize luteinizing hormone (LH) and follicle-stimulating hormone (FSH) ^1.2 . They activate the work of the ovaries and the production of sex hormones estrogen and progesterone.

Under the influence of estrogen and progesterone, the uterus prepares for pregnancy every month.The inner mucous membrane of the uterus grows, loosens and turns into a “feather bed”, ready at any time to receive the ovum. If pregnancy does not occur, the uterus gets rid of the unnecessary inner layer, it comes out along with the menstrual blood and everything starts all over again.

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Harbingers of the first menstruation

Female sex hormones – estrogens and progesterone – constantly circulate in a woman’s blood in varying amounts ^1.2 .In addition to the uterus, they affect other organs and systems ^1.2 . You will notice changes in them much earlier than menarche happens. Moreover, by their appearance, you can judge how soon the first menstruation will be.

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At what age do girls begin their periods?

In girls of the European race, the age of menarche often occurs at 12-13 years old, less often menstruation occurs at 10-11 years old and 13-14 years old ^1,2,3 .In the last 100-150 years, scientists have observed a noticeable decrease in the age at which puberty begins ² . Therefore, menstruation in a 9-10 year old girl no longer scares doctors and parents 90,030 2.3 . Rather, the absence of menstruation at the age of 14.5 is alarming 9030 2.3 .

All figures that we have given are average values. Everything may be a little different with you. Many factors influence the appearance of menarche:

1. Genetics. If your mom started menstruating later than her peers, then there is a chance that you too will have to wait a little bit ² .
2. Racial affiliation. Early menarche are characteristic of representatives of the Negroid race, Hispanics, and in Caucasians and Asians, menstruation begins later ² .
3. Nutrition. Adequate nutrition contributes to the formation of menstruation, but the diet delays puberty ² .
4. Body weight. In slightly plump girls, menstruation begins earlier than ² . But if the body weight is significantly higher than the norm, there is a delay in the onset of menstruation ² .

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What are their first periods?

Menstruation can last from 2 to 7 days – all individually ^{2 , 3} . When your period just begins, little blood is released from the vagina and it has a dark red color. Then it becomes larger and brighter. Sometimes, if your period is heavy, small blood clots sometimes appear in the discharge. There is no need to worry about this: in this way the body limits blood loss ² .

In the last days of menstruation, the amount of discharge decreases, they again become dark, sometimes almost black. This is because little blood is released from the uterus, it is retained in the vagina and is oxidized ^2.3 .

How much blood is secreted during menstruation? All girls have different ways. Some people lose only 20 ml of blood per day ³ . In others, the volume of blood loss approaches 80 ml ³ . On average, the amount of blood lost per day is equal to 30 ml ³ , which is approximately equal to the amount that 4 small tampons are capable of absorbing ² o.b.®. Over time, you will learn how to select hygiene products, taking into account your individual characteristics. And in order not to miss the onset of your period, we recommend that you use Carefree® panty liners on days when discharge may begin. They will protect your clothes and you will feel more confident.

Menses come cyclically, about once a month. The interval between the first day of one period and the first day of the next period is called the menstrual cycle ¹ .Its duration can be from 21 to 35 days ³ . Moreover, each woman’s cycle should be stable with a fluctuation of +/- 2 days ³ .

The first 12-18 months after menarche are often irregular, the interval between them can be shortened or lengthened up to 45 days ³ . Menstruation patterns can also change. They are often profuse and painful at first ³ . But gradually, over the course of 2-3 years, everything returns to normal ³ .

To control your cycle, we recommend that you keep a special menstrual diary or use the application on your phone, and in case of “emergency” situations, always contact your mother or doctor.

The information in this article is for reference only and does not replace the professional advice of a physician. Consult a qualified professional for diagnosis and treatment.

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Literature

1. A.O. Drobinskaya. Human Anatomy and Physiology / Textbook for SPO. – 2nd revised edition. – Moscow: Yurayt (Moscow), 2016 .– S. 252 -259.
2. Jennifer Knudtson, Jessica E. McLaughlin. Female reproductive endocrinology / 08.2016. – URL: https://www.msdmanuals.com.
3. N. Yu. Baranaeva. Normal menstrual cycle and its irregularities // Consilium-provisorum. – 2002. – T. 2, No. 3.

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90,000 When should a girl start her period? – Academic Medical Center (AMC)

The beginning of menstruation is a very important and very emotional moment in a girl’s life.At this time, the support and care of her mother is especially important to her, ready to help figure everything out. Mom is also not easy, because she is worried about her daughter’s health. All menstruation begins at different ages, and the specificity of the formation of the menstrual cycle also differs. To dispel anxiety and tell what is the norm and what is a dangerous symptom, agreed the candidate of medical sciences, doctor of the highest category, pediatric gynecologist Tatyana Valerievna Yudina.

Tatyana Valerievna, tell me, at what age should menstruation begin?

– Menstruation usually begins between 10 and 15 years of age.If a girl under 8 years old has had her period, or if a 15-year-old girl does not have it, this is a reason to see a doctor.

The period of puberty begins at 8 years old, and the appearance of menstruation at this age is no longer considered premature, but early. Given our ecological situation, this is not a pathology. I see many girls who have been menstruating since they were 8 years old.

After the onset of menstruation, intensive growth stops. If this happened at the age of 8, and the girl did not grow taller than everyone else in the class, you need to consult a specialist and temporarily stop menstruation.The gynecologist and endocrinologist will jointly prescribe hormone therapy that restrains sexual development.

How is the monthly cycle established in girls?

– The monthly cycle is set differently for everyone, but it should normalize within a year and a half. Normally, menstruation should last about 7 days with a frequency of 23-30 days. However, at first, your period may be irregular. During the period of formation of the menstrual function, breaks of 2-3 months are permissible and are a variant of the norm.

How abundant should the discharge be?

– The most important thing is that the gasket does not change every 2 hours. On the first day, 1 pad should be enough, on the second and third days – a maximum of 3 pads, and then downward. A few days, menstruation is more abundant, the rest – less.

If the bleeding is so strong that the pad has to be changed every two hours, this is a reason to run to the gynecologist, and just run, not walk!

What to do if your period didn’t start at the age of 15?

– So, you need to go to the doctor.First, it is necessary to exclude anomalies in the development of the external genital organs. The girl may have atresia – the absence of a hole in the hymen, there may be no entrance to the vagina and uterus, there may be hormonal disorders. These are the most complex pathologies, and there are many reasons for the delay in the onset of menstruation, including low body weight. The only reason not to worry is the late start of your mom’s period. In any case, if menstruation has not appeared before the age of 15, it is imperative that you go to the gynecologist for an examination on the chair and an ultrasound scan.

To learn more about the Department of Pediatric Gynecology at AMC and make an appointment with Tatyana Valerievna Yudina, follow the link.

90,000 Symptoms of the first menstruation in girls

The first menstruation is an exciting event in the life of any girl. During this period, important changes occur in the body. They are all natural and testify to your growing up. Symptoms of the first menstruation in girls appear shortly before the onset of menstruation. Noticing them, you can prepare for this important event in advance.In this case, the appearance of spotting will not come as a surprise to you.

When to expect the symptoms of the first menstruation?

Puberty occurs gradually. Usually, the first signs of maturation of your body become noticeable 2-2.5 years before the onset of menstruation. ¹ By carefully observing your body, you can guess when to expect your period. Most girls start menstruating when they are 11–12 years old, but there are exceptions.Most often they are the norm and simply reflect the individual characteristics of the development of the organism. Remember: the first menstruation can come at 10 years old, and sometimes they begin only after 15 years. ² If you are worried, talk to your mom or go with her to the pediatric gynecologist.

What changes happen to your body before your period?

Before menses begin in girls, the symptoms of hormonal changes in the body become more and more noticeable.The most characteristic features include the following.

Appearance of white discharge. Light vaginal discharge may indicate the approach of the first menstruation. They are white or transparent and do not have an unpleasant odor. Most likely, you will just notice small stains on your underwear. From the moment the discharge appears until the onset of menstruation, it can take just a few months or a whole year.

Changes in the figure as a result of hormonal changes in the body. What symptom before the first period in girls is impossible to miss? Of course, this is the formation of a female figure. This process begins approximately 2 years before the onset of menstruation. You will notice how your body is changing: your breasts are enlarged, your thighs take on new outlines, etc. All this happens under the influence of hormones. By the way, it is because of them that you can become more vulnerable and irritable during this period.

Emergence of premenstrual syndrome. ³ It is associated with a change in the balance of hormones in the second half of the menstrual cycle.Symptoms of the first menstruation in girls may be:

1. swelling of the mammary glands;
2. headaches;
3. discomfort in the lower abdomen;
4. increased appetite;
5. fatigue;
6. Frequent mood swings.

You can notice all these signs a few days before the onset of spotting. These symptoms before menstruation in girls manifest themselves in different ways. Some people hardly notice them, while others are very uncomfortable with premenstrual syndrome.

How does the first period start?

At the first menstruation in girls, symptoms appear the day before. You may notice unusual sensations: heaviness and even pulling pains in the lower abdomen, weakness and increased fatigue. The onset of your period is hard to miss. You will see reddish or reddish brown spots on your underwear. The appearance of blood is the main symptom of menstruation. The discharge may be light or heavy. Depending on their intensity, it is necessary to select a hygiene product.Symptoms of menstruation in girls may vary, this is absolutely normal, because each organism is individual. Menstruation usually ends in 3-5 days.

Tampons o.b.

^® for the first menstruation

Girls can use tampons o.b. ^® from the very first period. These hygiene products will help you feel comfortable and confident. With them, you will be able not to give up your favorite activities (for example, dancing or swimming) during critical days.Do not be afraid that a tampon can damage the hymen. During menstruation, it becomes elastic and stretchable, in addition, there is an opening in it for the outflow of secretions. Small tampons are ideal for girls – o.b. ^® ProComfort ^® Mini or Normal. When filled, they increase by only 10-15% of the original value. And thanks to the silky SilkTouch ™ coating, hygiene products are especially easy to insert and remove. You may be worried that the tampon might get lost inside your body.But this is not the case: you can always remove it simply by pulling on the durable lanyard. When used correctly, tampons are not harmful to your health. Just read the instructions carefully before using them or consult your gynecologist.

Literature:

1. Nikitina I.L.
   Start of puberty – well-known and new
   FSBI “Federal Center for Heart, Blood and Endocrinology named after VA Almazov “
   Ministry of Health of the Russian Federation, St. Petersburg, Russia
   Arterial hypertension.2013; 19 (3): 228-236
   https://cyberleninka.ru/article/n/start-pubertata-izvestnoe-i-novoe/viewer

2. Gritsinskaya V.L., Mamedova S.M., Nikitina I.L.
   Indicators of physical and sexual development of adolescent girls in St. Petersburg VA Almazov “Ministry of Health of Russia, St. Petersburg
   Reproductive health of children and adolescents. 2017; 6: 22-29
   https://cyberleninka.ru/article/n/pokazateli-fizicheskogo-i-polovogo-razvitiya-devochek-pubertatnogo-vozrasta-v-sankt-peterburge/viewer

3. Lisitsyna O.I., Khilkevich E.G.
   Premenstrual syndrome. New possibilities of therapy
   National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Acad. V.I. Kulakov, Ministry of Health of Russia, Moscow
   Medical Council. 2017; 13: 50-53
   https://cyberleninka.ru/article/n/predmenstrualnyy-sindrom-novye-vozmozhnosti-terapii/viewer

90 170 90 000 Menstruation. 10 facts for daughter

Menstruation is one of the stages of the menstrual cycle, which is a monthly rejection of the endometrium of the uterus, accompanied by bleeding, which occurs if the fertilization of the egg has not occurred.

Unfortunately, in our country, despite the availability of information, it is still not customary to discuss the topic of “critical days” in a family with growing daughters. Young mothers, having no experience of such conversations with their mothers, do not know where to start, when and what to tell a teenage girl about such a natural part of her life as menstruation . As a result, girls are often not ready for the first menstrual period and experience a real shock from what happens to their bodies.

10 facts about menstruation

In this article, we want to talk about the main facts that need to be told to a girl before her first period.

1. Menstruation is not a disease, but a natural process that occurs every month in a woman’s body, which speaks of her health. The arrival of the first menstruation suggests that the girl is becoming a girl and in the future will be able to have children.
2. Growth of pubic hair and armpits, oily sheen at the hair roots, the appearance of acne – indicates that hormonal changes have begun in the body and the first menstruation will soon begin.
3. The first menstruation is normal from 11 to 14 years old. At first, they may be irregular, but over time, the cycle is established.
4. The menstrual cycle (the period from the first day of the onset of menstruation to the first day of the next menstruation) is individual for each woman and can range from 21 to 35 days.
5. Menstruation itself can last from 3 to 7 days. During this time, the body normally loses no more than 30-50 ml of blood.
6. Menstrual flow may contain clots – this is normal.
7. Mild pulling pain in the lower abdomen is normal during menstruation.
8. Severe pain, profuse discharge, weakness during menstruation, delay in the established menstrual cycle for more than 10 days should be a reason for seeking medical attention.
9. During menstruation, it is necessary to observe strict rules of personal hygiene:
• use disposable pads;
• change them at least every four hours;
• wash with warm water;
• do not take a bath, but use only a shower;
• Avoid swimming in pools or open bodies of water.

10. In the first days of menstruation, it is better to avoid sports. You can resume them closer to the end of the cycle, when the discharge has already decreased.

In conclusion, I would like to note that a regular visit to an obstetrician-gynecologist at a medical center is a necessary part of the prevention of diseases of the female body. A teenage girl should clearly understand that a gynecologist is a specialist who, in case of problems with women’s health, will always provide her with support and assistance.

90,000 PMS | Symptoms, signs of premenstrual syndrome

PMS is a cyclical complex of symptoms that appears 3-10 days before menstruation, characterized by individual deviations from the endocrine, neuropsychic and vegetative-vascular systems. Premenstrual syndrome is observed in every second woman who monthly experiences a decrease in mood, sharp headaches and muscle pains, apathy, depression. In some cases, there are: increased aggressiveness and irritability, swelling, skin rashes, nausea, sensitivity to odors.Such manifestations are a deviation from the norm, and therefore require immediate medical intervention.

The gynecological department of the Elena Malysheva clinic provides assistance to patients of all ages with PMS. Experienced specialists carry out examination and diagnostics in order to identify the causes of the disease and prescribe an effective treatment. When symptoms of premenstrual syndrome appear, you should consult a gynecologist in a timely manner in order to reduce the risk of a worsening of the situation, establish a cycle, and return a full sense of life.

Causes of PMS

Many people mistakenly believe that premenstrual syndrome is associated with psychological disorders. However, the pathological condition is based on hormonal disorders: disruptions in the production of hormones progesterone and estrogen, an increase in prolactin levels, fluctuations in endorphins. In addition, the following reasons for PMS can be distinguished:

• frequent stress and anxiety.
• increased fatigue.
• hereditary predisposition.
• diseases of the thyroid gland.
• violation of the water-salt balance.
• Malnutrition with insufficient intake of calcium, magnesium, zinc, vitamin B6.

To identify the causes of PMS before menstruation, in order to eliminate them, you can together with a doctor who will comprehensively assess the state of your body in the process of diagnosis.

Symptoms and signs of premenstrual syndrome

Highlighting the symptoms of PMS in women, it should be noted that the disease can develop in several forms:

• Psychovegetative.It is characterized by: depression, tearfulness, resentment, forgetfulness, fatigue, weakness, a tendency to worry. Outbursts of anger, rage, irritability, and conflict are also often manifested. All these signs of PMS before menstruation can occur against the background of insomnia, constipation, increased sensitivity to odors, and numbness of the hands.
• Edematous. There are swelling of the face, hands and feet, acne, sweating. There is also an increased sensitivity of the mammary glands, weakness and pain in the muscles.
• Cephalgic. In this case, the symptoms of premenstrual syndrome are expressed in the form of paroxysmal headaches, nausea, and dizziness. Facial redness and swelling may occur.
• “Crisis”. It is characterized by an increased feeling of fear, the appearance of the so-called “panic attacks”, when the heart rate increases, the pressure rises, and the fear of death appears. Such signs usually appear during premenopause, accompanied by the development of pathologies from the cardiovascular system, kidneys and gastrointestinal tract.
• Atypical. The main symptoms include: asthma attacks, migraines, fever, stomatitis, and ulcerative gingivitis.
• Mixed. It can manifest itself in various deterioration in well-being at certain stages of the menstrual cycle.

It should be noted that the described list of PMS symptoms in women is not complete, because signs of pathology depend on the general condition of the body, as well as its individual characteristics. In addition, the symptoms of premenstrual syndrome in women appear depending on the stage of the disease, which can be:

• Compensated.Minor symptoms before menstruation, which do not develop with age.
• Subcompensated. The pronounced symptom complex is aggravated over the years.
• Decompensated. All signs are severe and also persist until the end of menstruation.

Diagnostics

To understand how to cope with PMS, it is important to carry out diagnostics, which are performed in stages:

• The gynecologist conducts a conversation with the patient to identify the main complaints, to find out the cyclicality of attacks, the degree of deviation from the norm.
• The doctor examines the patient, which makes it possible to exclude other gynecological diseases.
• Tests are scheduled. A blood test is taken for hormones (progesterone, estradiol, prolactin).
• An examination is carried out using an ultrasound machine.

Tests can also be prescribed:

• measurement of daily urine output;
• electroencephalogram;
• blood pressure control;
• MRI and others.

Diagnostics is carried out in a comprehensive manner with the involvement of other specialists, which makes it possible to compile a complete picture of the disease.

PMS Treatment

In some cases, the manifestations of premenstrual syndrome are similar to other diseases that must be excluded during diagnosis. This can only be done by the attending physician. At the same time, it is important to take into account that PMS syndrome takes on a new form with age. It is important to determine the nature of the disease, its causes as early as possible, in order to prescribe treatment in a timely manner and reduce undesirable consequences.

Regardless of the form and signs of PMS, treatment is prescribed in a comprehensive manner. It consists of therapy aimed at:

• Improvement of the psycho-emotional state.
• Normalization of hormonal levels.
• Fight against puffiness.
• Elimination of symptoms.
• Improving immunity and preventing side effects from drug therapy.

IMPORTANT! When prescribing treatment, the doctor also gives general recommendations or develops a special program for nutrition, physical activity, herbal medicine, and sleep patterns.

The compiled complex of treatment will help each patient to improve their well-being in the period before and during menstruation.

Benefits of treatment in the medical center of Elena Malysheva

By contacting the Elena Malysheva clinic to relieve PMS syndrome in women, you can be sure that you will be provided with qualified assistance here. After all, the medical center employs certified specialists. In addition, we guarantee a number of other benefits:

• Reasonable prices in Izhevsk.
• Advanced methods of treatment of diseases.
• Comfortable treatment conditions.
• Reception of patients on the day of treatment.
• An integrated approach to diagnosis and treatment.

Remember that only an experienced specialist can not only improve your well-being, but also tell you how to alleviate the condition of PMS, focusing on the individual characteristics of the body, select an effective therapy that will help overcome the painful condition.

You can ask questions and make an appointment with a gynecologist by calling (3412) 52-50-50 or on the clinic’s website.

The menstrual cycle – what is it, the main symptoms and phases of the period of menstruation | The norms of the days of menstruation, the intensity of bleeding

After the first menstruation, a cycle of ovulation and menstruation is established in your body, which lasts about 28 days. But how does this all happen?

The menstrual cycle is a natural part of every woman’s life.In order to understand how it happens and how long your period lasts, you need to study the female anatomy.

Hymen

Soft, elastic layer of skin with an opening that surrounds the vaginal opening from the outside. Many girls’ hymen are destroyed long before they lose their virginity.

Vagina

Elastic muscular tube. At first, the vagina is narrow, but in depth it expands.

The vagina connects the uterus with the external genitalia.The vaginal opening is located between the urethra and the anus.

Cervix

Entrance to the uterus and vagina

Uterus.

Has compacted muscle walls and a small cavity, the walls of which are covered with a mucous membrane.

Fallopian tubes

Through them, the fertilized egg enters the uterus with the help of tiny villi.

Ovaries

Eggs mature inside them.

Endometrium

The fertilized egg is located in this glandular tissue.If the egg is not fertilized, the glandular tissue is expelled from the body during menstruation.

Pelvic floor muscles

Keeps the genitals in place.

Clitoris

Located in front of the urethra, between the labia minora, it is a cluster of nerve endings that cause sexual arousal.

Labia

The entrance to the vagina is surrounded by the outer (large) and inner (small) labia.

The structure of the female genital organs

The external genital organs of a woman include large (labia majora) and small (labia minora) labia and clitoris. Small lips border the opening of the urethra (urethra) and the vestibule of the vagina. The point of their connection is the clitoris, covered with a thin mucous membrane, the so-called mucose. The clitoris, due to its sensitivity, plays a significant role in sexual arousal. Inside, the vagina is connected to the cervix, which is its lower part.Further, the uterus expands, and it is into it that the egg enters, and the embryo and fetus develop during pregnancy.

Ovulation

When your body is producing enough sex hormones, approximately every 4 weeks, one egg will mature in one of your ovaries. The ripe egg leaves the ovary and moves to the fallopian tubes. This process is called “ovulation”. During this period, you may experience more abundant and transparent discharge.

Fallopian tubes

Over the next 4 days, the egg moves through the fallopian tubes to the uterus

Location of the egg

At the same time, the endometrium (uterine mucosa) thickens to create the most comfortable place for blood cells for subsequent placement of the eggs vessels and supplied with nutrients.

Menstruation

If the egg is not fertilized, it leaves the body along with menstrual flow. The place prepared for the development of a fertilized egg also becomes unnecessary. Approximately 2 weeks after ovulation, the upper layers of the endometrium are rejected and excreted from the body in the form of menstruation. With the onset of menstrual flow, a new egg begins to mature and a new cycle begins.

Menstrual cycle and its phases

The duration of the menstrual cycle is about 28 days.However, it is recognized that a normal cycle can last anywhere from 21 to 35 days. All processes occurring in a woman’s body are conventionally divided into several phases.

Menstrual phase. This is the time of bleeding from the uterine cavity. During this period, lasting from 3 to 6 days, the body rejects the layer of the mucous membrane – the endometrium, to which, in the event of pregnancy, a fertilized egg should have attached itself.

Follicular phase. It begins at the same time as menstrual and lasts an average of 14 days. In this phase, a new follicle is formed in the ovaries – a special component in which a new egg matures. In addition, the process of renewal of the endometrium in the uterus begins.

Ovulatory phase. It lasts about 3 days, during which time, under the influence of hormones, the mature follicle ruptures and a mature egg cell ready for fertilization emerges from it. This process is called ovulation.During ovulation, some women may experience pain in the lower abdomen, on the side where the egg was released.

Luteal phase. It lasts 11-16 days. At this time, the hormones estrogen and progesterone are actively produced, which prepare the entire body for pregnancy. In the luteal phase, a phenomenon such as premenstrual syndrome (PMS) is common. This is a complex of symptoms associated with a natural change in hormonal levels: normally, before the days of menstruation, a woman may experience pain in the lower abdomen, increased appetite, mood changes, swelling of the mammary glands, etc.

Days of menstruation

Let us consider in more detail what changes in the female body occur during menstruation.

Day 1. At the beginning of the menstrual cycle begins with the rejection of the “old” endometrium – a special layer of the uterine lining – and the bleeding itself. This process, necessary for the female body, often becomes one of the most uncomfortable periods of everyday life. Unpleasant sensations during menstruation are the norm and are caused by uterine contractions.

Day 2. On the second day of the monthly cycle, soreness and heaviness in the abdomen may persist. Meanwhile, the body begins to form a new egg. During menstruation, due to hormonal changes, the work of the sebaceous glands can change, so it is important to pay special attention to personal hygiene.

Day 3. After rejection of the “old” endometrium, a wound surface is formed on the walls of the uterus. At this stage of the menstrual cycle, the risk of infection is especially high, therefore gynecologists recommend abstaining from sexual activity while menstruation lasts.

Day 4. By the 4th day of the menstrual cycle, the woman’s well-being improves, but with menstruation, it is still worth limiting physical activity and trying not to overwork. If these recommendations are followed, the volume of blood loss during menstruation decreases.

Day 5. As a rule, periods last 5 days, however, there may be individual discrepancies. During this time, the healing process is completed in the uterus. In the renewed body, the metabolism is accelerated, and the woman feels much better and more vigorous compared to the beginning of the menstrual period.

Intensity of bleeding

Bleeding, which we call “discharge” or “monthly”, is not always the same in intensity. Various life circumstances – having a baby, diet, stress, different methods of contraception – can affect how long your period lasts and the intensity of discharge during this period. It is different for different women, and also sometimes differs for the same woman in different menstrual cycles – all this is not a deviation from the norm.Therefore, tampons are available in many formats and with varying degrees of absorbency. By choosing the right product, you will be protected and will be able to feel comfortable on any day of the month – so that nothing stands in the way of enjoying life without compromise, even during your period. Use our tampon selector to find out which tampon is right for you. Talk to your GP or gynecologist if you have questions about your period or problems with your menstrual cycle.

Rules of conduct and hygiene during menstruation

Relaxation can help relieve pain during menstruation.Activities that promote blood circulation will help relieve cramping. Take a walk, ride a bike, put a heating pad on your stomach, or take a warm bath.

It is important before menstruation to do those things that bring you pleasure: chat with friends, buy yourself a favorite treat, sleep more, in a word, do what will help neutralize the negative symptoms of PMS (premenstrual syndrome).

Water will help to cope with bloating and reduce fluid retention in the body before menstruation.Believe it or not, it can actually reduce PMS symptoms. Eat vegetables and fruits with a high water content, drink warm herbal tea, juices. Add foods high in magnesium and vitamin E to your diet (dried apricots, bananas, avocados, etc.). It is recommended to reduce the consumption of black and green tea, coffee, salt and sugar.

During menstruation, you must follow the rules of personal hygiene: use pads or tampons to absorb secretions, take a shower every day, wash yourself 2-3 times a day.Experts recommend stopping sex during menstruation.

When an angel turns into a devil … about women’s critical days (PMS)

Petersburg historian Viktor Mikhailovich Evstigneev writes about the attitude to menstrual days in Greece and Sparta: “The women’s cycle was treated quite simply. “Critical days” were not shy, they were perceived as the norm, in which there is nothing shameful. In Rome and Sparta, sports games were often held among women.The participant could refuse the competition only for a good reason. One of them is “critical days”. They were announced publicly, explaining the absence of the athlete. This is proved by a scroll found in 1985 in northern Italy. This document regulated the rules of sports games, including those for women. And the point about “women’s week” was one of the first to appear there. “Women’s week” included a few days before menstruation. Since at this time, many of the fairer sex suffered from poor health.This fact is reflected in the way of life. Usually the Roman woman spent most of her time in the female half. Of the men, only the husband had the right to enter. Even a slave could not look into the chambers of his mistress. This rule was indisputable. If the house was on fire, and it was necessary to save the mistress, then only her husband could get her out of the female half. Otherwise, the woman had every chance of suffocating in the smoke. There was another indisputable rule. The husband could visit his wife at any time. She had no right to refuse the meeting, otherwise the woman would face severe punishment – up to physical.The usual daily routine could only change the female cycle. On the eve of her “critical days,” a woman had the right to deny her husband access to her half. What is now called premenstrual syndrome made a woman untouchable. She could contradict the wishes of her husband with impunity. Moreover, during the premenstrual days, a woman could not perform duties related to household chores. Even irritability, grumpiness and aggressiveness were forgiven to the Romans. On ordinary days, the inhabitants of a great empire had to behave nicely, docile and compliant.”The attitude of men to women’s” menstrual days “has not changed throughout the history of mankind.

In 1887, the book “Woman in the period of her monthly cleansing” was published in Paris. In one of the chapters of this book, the author answers his question “Why shouldn’t we trust a woman to solve important state issues?” so: “How can you trust a being who every month for 2 weeks under the influence of internal changes is able to perform actions that she herself will regret …?”

This is all about premenstrual syndrome. When we say the word PMS and mean irritability, aggression, or vice versa apathy and tearfulness, we are talking only about the tip of the iceberg in the many-sided manifestation of premenstrual syndrome or dysmennorrhea.

Here are some facts about PMS. Unfortunately, PMS is one of the most common forms of gynecological pathology in the age from the onset of menstruation to their cessation, that is, from the first menstruation to menopause.It is also interesting that, in fact, PMS is one of the most statistically unreported forms of female disorders. Everyone knows about erosion, they treat mycoplasmas, ureaplasmas and share their experience in contraception with each other, but there is no data on PMS among doctors and among patients. And indeed, more recently, recognition of oneself and one’s friends in pronounced PMS, and even more contacting a doctor with a desire to recover from premenstrual syndrome, was considered a sign of bad tone. In addition, even by us, doctors, PMS was practically not recorded, although severe forms of PMS are one of the reasons for getting an official sick leave!

In recent decades, many countries have started to keep statistics on this issue.Pay attention to the data from these studies. On average, PMS occurs in various forms from mild malaise to severe emotional changes in 95% of women in the population. Just think: almost every woman encounters a variety of forms of premenstrual disorders, and 5-10% of women in the period of premenstrual syndrome generally lose their ability to work! Now I understand why our English teacher, a young woman, skipped our lessons every month. The whole school knew that she had critical days, but sometimes she still came to our classes, and then we skipped classes.

In women prone to hormonal changes, high body weight and other endocrinological problems, PMS occurs from 25 to 75% – and this is a significant figure. Interestingly, premenstrual syndrome always occurs in the second phase of the menstrual cycle, that is, on those days that are closer to menstruation, and passes with the onset of menstruation. Thus, among doctors, the opinion was formed that pre-mesntrual disorders are associated with an imbalance of hormones and, most of all, with hormones of the second phase of the menstrual cycle.These hormones are progestins (or progestogens). That is why the modern aspects of PMS treatment are manifested in changing the nature of the menstrual cycle (reducing the time of menstruation by using drugs in 24 + 4 modes) and using new constituents of contraceptives that affect the inner uterine layer and the gestagenic component of the menstrual cycle (dienogest, drosperinone).

PMS manifests itself in different ways in different women. As one of the classics of Russian literature said: all happy families are equally happy, and unhappy ones are unhappy in their own way.No two women have the same symptoms of PMS. This is the whole problem, because if we take, say, erosion of the cervix, then we can distinguish up to 10 different types of erosion and classify women according to all these 10 signs, while there are more than 100 manifestations of PMS. depend on social status and lifestyle, and can be observed in the beautiful half of humanity in various social strata, making a devil in the flesh out of an angel woman. At such moments, men are more than ever waiting for the onset of menstruation, foreshadowing the abatement and then the complete disappearance of unpleasant symptoms, when the frog again turns into a beautiful princess, giving her kindness and warmth to a man already exhausted by the luteal phase of the menstrual cycle.

I will list you some of the most striking symptoms of premenstrual syndrome: mood swings, depression, tension in relationships with people around you (two women with PMS in the same room can destroy not only each other, but also a large company or training company). Add to this anxiety, aggression and loss of control over the situation and you will look at the world of these women in a completely new way. Some, however, develop symptoms of lethargy, amorphous behavior, and impaired eating habits against the background of general irritability.But these are only external, visible symptoms. During this period, a woman really cannot be envied: swelling, slight enlargement and engorgement of the mammary glands, pain in the nipples, a feeling of bloating in the abdomen, hot flashes, headaches and sometimes accompanying ACNE (rashes in the forehead, oily sheen on the skin). What could be worse than a dull mood in the morning, when you look at yourself in the mirror and in horror realize that you are ready to kill everyone who pays attention to this terrible rash on your face.

To date, the causes of PMS are recognized as a genetic predisposition and a violation of the interaction of sex hormones, which manifests itself in the general vulnerability of the hormonal system to fluctuations in hormones in the second phase of the menstrual cycle.This is the secret of PMS – it is not the absolute level of the hormone progesterone that is important, but the increase in the sensitivity of the woman’s central nervous system to this hormone. In simple terms, fluctuations in hormones during the menstrual cycle and impaired metabolism of progesterone and its metabolites in the brain are one of the causes of PMS at the current level of understanding of this problem.

Modern gynecology distinguishes between two types of premenstrual disorders – premenstrual syndrome (PMS) and premenstrual dystrophic syndrome (PMDD).To diagnose PMS, at least one of the listed symptoms of mental disorders (affective disorders) and one of the symptoms of metabolic disorders (somatics) must be observed. Mental disorders are: depression, outbursts of anger, anxiety, confusion, irritability and a desire to leave or isolate oneself from society for a few days before the onset of menstruation and the symptoms subside (self-isolation). Physical disorders include breast engorgement, bloating, headache, and swelling of the arms or legs.If these symptoms appear 5 days before the onset of menstruation and stop 4 days after its onset, you should visit a gynecologist-endocrinologist and decide on a treatment strategy for PMS. If you think that this condition is just an accident, remember that the American Association of Obstetricians and Gynecologists found that in the previous three cycles and the next two cycles of observation, the appearance of at least two of the listed symptoms within the above terms, reliably confirms the premenstrual symptom and requires it treatment.

A little more time is needed to diagnose PMDD. Symptoms should accompany the woman’s life for at least a year (the so-called prospective study or analysis of past menstrual cycles) and are observed now in at least two cycles. Let’s say the menstrual cycle for this month and the next. The analysis is carried out taking into account five of the listed symptoms, one of which must still prevail: depression, anxiety and tension in communicating with others, pronounced emotional lability, anger, irritability, decreased interest in work and habitual activities, difficulty concentrating on tasks, fatigue, lethargy, changes in appetite and food preferences, feelings of depression, and physical symptoms common to PMS.By analyzing these symptoms, the doctor can accurately diagnose PMS or PMDD. Of course, a doctor’s consultation is necessary, but additional laboratory and hormonal examinations, as a rule, are not always advisable. Treatment consists in the fact that it is necessary to exclude the ovulation process, that is, to create a model of the menstrual cycle with an even distribution of hormones throughout the month and change the very cycle of the menstrual cycle, therefore the most promising method of treatment is still the appointment of hormonal contraceptives.An analysis of the methods of using various COCs showed that the use of three-phase contraceptives that simulate the natural surge of hormones, but remove ovulation, does not lead to progress in the treatment of PMS, but monophasic COCs can achieve significant improvement. The question is also that the standard regimen of COC intake is 21 days + 7 days of a break, during which the menstrual reaction passes and the PMS symptoms return, therefore, the issue of the COC regimen itself has recently been given great importance.If COCs are prescribed to relieve PMS symptoms, then the 21 + 7 regimen is not optimal. The mode of 21 + 21 + 5 days off has proven itself well, that is, 2 packs of COCs (42 days) are taken and then a break is taken for 5 days. But this regimen should be accompanied by the use of modern contraceptives with innovative gestagens. This introduces some confusion about the regularity of menstruation. In addition, one should take into account the fact that when taking combined contraceptives, symptoms of fluid retention in the body may occur, and therefore breast engorgement, swelling of the extremities, headaches, bloating and depressed mood, which provokes PMS or reduces the effectiveness of treatment.