So, You Think You Have PMS...
Having one or two symptoms doesn't mean you're really experiencing PMS, and if you're struggling with intense period-related emotional issues, it could be another condition entirely. Here's how to tell the difference.
By Alyson McNutt English
Medically Reviewed by Niya Jones, MD, MPH
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Premenstrual syndrome (PMS) is a real condition that millions of women struggle with every month. But — brace yourself — a lot of ladies who think they've got PMS either have symptoms that are too mild or too severe to be PMS.
According to the American College of Obstetricians and Gynecologists, 85 percent of women have at least one symptom of PMS during their monthly cycle, but most of these symptoms are mild and do not reflect a diagnosis of true PMS. And on the opposite end of the spectrum, women who experience severe emotional distress before their periods don't have PMS, but a more serious condition known as premenstrual dysphoric disorder (PMDD).
PMS: What Is It, Really?
While it's easy to assume that any bad mood that comes on right before your period is PMS, says Andrea Sikon, MD, a gynecologist at the Center for Specialized Women’s Health at Cleveland Clinic, PMS isn’t as common as many women think.
“There are guidelines to define PMS, which consists of the recurrence of both physical and behavioral symptoms that interfere with some element of functioning during the second half of the menstrual cycle,” notes Dr. Sikon. “If one applies the strict clinical criteria, only 30 percent of women may have actual PMS.”
There are some groups of women, however, who are more likely to experience PMS than others, including those who:
PMS: What Are the Symptoms?
While the symptoms of PMS vary from one woman to another, these are some of the more common manifestations:
- Difficulty sleeping
- Upset stomach, bloating, diarrhea, or constipation
- Skin blemishes
- Back pain
- Breast tenderness
- Changes in appetite or food cravings
- Muscle pain
- Inability to concentrate
- Mood swings
- Irritability or depressed mood
Is It PMS or PMDD?
Only 3 to 8 percent of women have PMDD, or premenstrual dysphoric disorder, the more severe form of PMS, notes Sikon. According to the American Psychiatric Association DSM-IV criteria, PMS leads to physical as well as emotional symptoms whereas only emotional symptoms have to be present for a woman to be diagnosed with PMDD. “However, the symptoms must be prior to menses, resolve with the onset of menses, be disruptive to functioning, and be recurrent,” Sikon says.
PMS: Medication and Treatment
One of the first medications a gynecologist will consider in treating PMS is the birth control pill. Birth control pills can help regulate a woman's hormones and can offset the intensity of physical symptoms and mood swings. If birth control pills don’t resolve mood-related symptoms, it’s not unusual for gynecologists to recommend an antidepressant as well.
Sikon says some women take offense at being offered an antidepressant, and may feel it means the doctor doesn’t think her symptoms are real, but it’s actually quite the opposite. “These antidepressant or anxiety meds likely work because changes in hormone levels alter neurotransmitters like serotonin, which mediate many things in the body, including pain and mood,” she explains. “As these medications help to influence serotonin levels, they can be used for many indications rather than just for depression. So if you’re doctor is giving you an antidepressant, it isn’t because she thinks your symptoms are ‘in your head.’ ” Sikon adds that some women may not need to take the antidepressant the entire month and can benefit simply by taking it in the two weeks before their period begins. Others, however, may find an antidepressant more effective if they take it every day.
Sikon also recommends limiting caffeine intake to minimize PMS-related breast tenderness, and taking non-steroidal anti-inflammatory medications (NSAIDs, such as ibuprofen and naproxen) to diminish menstrual cramps and heavy bleeding.
One widely touted treatment that may be useless? Vitamin B supplements. According to a recent article inJournal Watch Women's Health, the results of studies are inconsistent, and women should forgo supplements and focus instead on eating a well-balanced diet with plenty of foods high in B vitamins (green leafy vegetables, legumes, seafood).
If you experience any PMS symptoms that interfere with your day-to-day life, it’s time to seek medical help. “Always talk to your doctor about any symptoms that seem out of the ordinary or are disruptive to your ability to get through your day,” advises Sikon. There are treatments available that can help you cope.
Video: WHAT PMS IS REALLY LIKE
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