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What is premenstrual syndrome?
Also known as PMS, premenstrual syndrome is a group of symptoms that may begin one or two weeks before menstruation. PMS may be worse some months and better other months. It is most common in women between the ages of 25 to 40.

What causes PMS?
We don't know for sure but one reason could be monthly fluctuation of hormones. Other things that may make PMS worse are poor diet, lack of exercise, and/or eating or drinking too much caffeine. It is also more likely to happen to you if your mother or other women in your family had PMS. Symptoms can be dramatically worse if you have a lot of stress or suffer from depression or anxiety.

What are the signs and symptoms of PMS?
Symptoms may range from mild to severe. They usually go away within hours to days after menstrual bleeding starts. Some symptoms may include:

• You may feel mad, tense, irritable, nervous or sad.
• You may feel hungry and crave foods like chocolate, sugar or salt.
  
• You may be moody, have crying spells or want to be left alone.
  
• You may have less energy, feel tired, or have trouble sleeping.
  
• You may have trouble thinking, focusing on tasks, or remembering things.
  
• You may notice weight gain or swelling in the lower belly, ankles and breasts.
  
• Your acne may get worse.
  
• You may get headaches or migraines.
  
• You may have changes in your bowel movements.
  
• You may have less interest in sex or less pleasure from it.
  
• You may have backaches or other general aches and pains.

What can be done for PMS?

• Yoga, relaxtion exercises or biofeedback.
• Exercising at least 3-5 days per week for 30-45 minutes at a time.
  
• Avoid alcohol or caffeine.
  
• Avoid nicotine (tobacco products).
  
• Sleep well.
  
• Avoid fat, sugar and salt.
  
• Eat more fiber (25-30gms/day)
  
• Increase the amount of fruit and veggies in your diet. These are anti-inflammatory.
  
• Increase omega 3 fatty acids in your diet.
  
• Try acupuncture.
  
• Try the following supplements:
  
  • Calcium carbonate 1200-1600 mg/d
    
  • Magnesium citrate 300-400 mg/d (or Mg oxide - less GI side effects)
    
  • Vitamin B6 50-100 mg/day
    
  • Vitamin D to optimize levels
    
  • Chastetree Berry (vitex agnus castus) 500 mg/d of dried chastetree fruit
    
  • Black cohosh (Actaea racemosa) 40-160 mg/d of an extract made from the dried root and rhizome
    
  • St. John's wort (Hypericum perforatum) 900-1500 mg per day in 2-3 divided doses
    
• Try the following medicines:
  
  • Start ibuprofen, naproxen or other anti-inflammatories a couple days before the symptoms appear.
    
  • Prescription medications most often include water pills, antidepressants or hormonal contraceptives. Ask your doctor if these might be for you.

Jessica Johnston, M.D. NCMP
Family Practice