Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

What is PMS?

PMS (premenstrual syndrome) is the name of a group of physical, emotional and psychological symptoms that occur in the last two weeks of the menstrual cycle. PMS is very common, affecting four out of ten women. While most women have some discomfort before their periods, women with PMS have symptoms that can affect the quality of their lives and/or ability to do normal activities.

What causes PMS?

While it is not known what causes PMS, it is likely that changing hormone levels and brain chemistry play a role. Diet, activity level and stress may also be related to the severity of symptoms.

What are some of the symptoms of PMS?

There are over 150 symptoms that have been linked to PMS. Some of the more common ones are:

Emotional:
Depressed mood
Anger
Irritability
Feeling of loss of control
Tension
Restlessness
Anxiety

Physical:
Bloating
Weight Gain
Abdominal Pain
Muscle and/or joint pains
Breast pain and swelling
Headache
Fatigue
Difficulty sleeping
Dizziness

Psychological:
Difficulties concentrating
Forgetfulness
Confusion
Food cravings
Lack of sexual interest
Decreased efficiency

How do I know if I have PMS?

The best way to diagnose PMS is to keep track of your symptoms on a calendar for at least three months. If your symptoms follow a pattern each month, then you may have PMS. Your doctor may want to do some other tests to rule out other medical problems.

How is PMS treated?

Women with mild or moderate symptoms may get enough relief from changes in lifestyle alone. A healthy diet rich in complex carbohydrates like whole gain bread, rice, pasta and cereals, may help to relieve symptoms. Regular aerobic exercise for twenty minutes at least three times a week may also be helpful and has other health benefits as well. It is also known that stress makes PMS worse. Therefore doing things that you find relaxing and avoiding stressful activities for at least the week before your period may ease your symptoms. It is important to understand that it may take a few months before you notice any improvement.

Are there any medicines that help?

Women with severe symptoms and/or for whom lifestyle changes are not enough may benefit from medicines. One group of medicines is called the selective serotonin reuptake inhibitors or SSRIs have been shown to improve emotional symptoms. These may be taken daily or during the last half of your cycle. Some anti-inflammatory medicines (some examples are Ponstan and Naproxen) may also help relieve physical and emotional symptoms if taken for the week before and first few days during your period. Some women also benefit from hormonal treatments and from a fluid pill called Spironolactone. Your doctor may have to try a number of treatments before finding the one(s) that work the best for you.

Are there any vitamins or natural treatments that help?

Recently, a large study showed that calcium (1200 mg/day) helps reduce PMS symptoms. Calcium is also important for bone health. Another mineral, magnesium (360 mg/day) may also help reduce the swelling of PMS. Vitamin B6 (50 mg/day) and evening primrose oil (500 mg three times a day) may help some women although the research on this is not clear. It is important that if you take any over-the-counter vitamins or other supplements, not to take more than the recommended amount as they may be dangerous in large amounts. There have not been many scientific studies done on herbal treatments for PMS. Dandelion, borage seed oil and black cohosh may be helpful. It is very important to check with your physician before taking any of these products as they should be avoided by women on certain medicines and with certain health conditions.

PDF Version

Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.