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.

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

Severe symptoms can significantly affect quality of life, relationships and ability to function.

Severe symptoms may be associated with suicidal ideation. 

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), Vitex (Chaste tree).

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 (Lupron). 

Serotonergic reuptake inhibitors (SSRIs or SNRIs)