Premenstrual Syndrome (PMS)

  80-90% of women experience symptoms alerting them about the upcoming menstruation: breast tenderness, bloating, acne, cravings, Joint pain, irritability, headaches, migraines

Appears to worsen in the 30-40s 

Very common: up to 90% of women suffer.

Symptoms are severe in 3-5% of women, which is called premenstrual dysphoric disorder (PMDD)

Severe PMS with one of :

• Marked affective lability (mood swings, sad or tearful, sensitivity to rejection)
• Marked irritability or anger or interpersonal conflicts
• Marked depressed mood, hopelessness or self-depreciating thoughts
• Marked anxiety, tension, or being on edge

There is evidence for exercise, Vitamin B6 (100mg), Vitamin D (1000 IU), optimizing calcium intake (1200mg), magnesium supplementation (up to 1000mg), and eating a high tryptophan diet. 

Cognitive behavioural therapy (CBT) can also help. 

Download the chart here.  Two months of prospective tracking are required to make a diagnosis of PMDD.

https://www.stjoes.ca/women-s-health-concerns-clinic/women-s-health-concerns-clinic/women-s-health-concerns-clinic/women-s-health-concerns-clinic/mac-pmdd.pdf

Hormonal suppression: combined oral contraceptive pill (taken continuously or in the usual fashion); other hormone therapy; GnRH agonists

Serotonergic reuptake inhibitors (SSRIs or SNRIs)