WHAT YOU NEED TO KNOW:

What is premenstrual syndrome? Premenstrual syndrome (PMS) is a group of physical, emotional, and mental changes that occur before your monthly periods. These symptoms may begin 1 or 2 weeks before your period starts.

What causes PMS? Healthcare providers do not know for sure what causes PMS. Monthly changes in hormone levels may cause PMS. You may be more likely to have PMS if someone else in your family has it. Changes in brain chemicals may also cause or worsen PMS. A lack of healthy foods, too much caffeine, or not enough exercise can make PMS worse. Symptoms of PMS may be worse if you have a lot of stress or you have a mood disorder, such as depression.

What are the signs and symptoms of PMS? PMS symptoms may range from mild to severe. They usually go away within hours to days after your monthly period starts.

• Irritability, depression, crying spells, or decreased interest in daily activities
  
  
• Trouble thinking, focusing on tasks, or remembering things
  
  
• Weight gain or swelling in your abdomen, ankles, hands, or face
  
  
• Acne
  
  
• Headaches, backaches, or swollen, tender, painful breasts
  
  
• Constipation or diarrhea
  
  
• Increased hunger or food cravings
  
  
• More tired than usual or trouble sleeping

How is PMS diagnosed?

• Your healthcare provider will ask about your symptoms. Use a diary or calendar to keep a record of your menstrual cycle each month. This record should include the dates that your periods start and stop. Also include your symptoms, such as mood changes and changes in your body. Write down if your symptoms were mild, moderate, or severe. Record your symptoms for at least 2 of your monthly periods so your healthcare provider can check for any patterns.
  
  
• Your healthcare provider may examine you to check for other possible causes of your symptoms. You may need blood tests to check your hormone levels. You may also need a pelvic exam so your healthcare provider can check your vagina, cervix, and uterus for problems.

How is PMS treated? You may not need any treatment for PMS. The following can help relieve your symptoms:

• Ibuprofen: This medicine decreases pain and swelling. Ibuprofen is available without a doctor's order. Ask how much to take and how often to take it. Follow directions. Ibuprofen can cause stomach bleeding and kidney damage if not taken correctly.
  
  
• Diuretics: This medicine helps your body get rid of extra fluid.
  
  
• Antidepressants: This medicine may be given to help improve your mood or behavior. Sometimes it is given only during the last 2 weeks of the menstrual cycle. Some vitamins, herbal supplements, or food supplements may interact with this medicine. Ask your healthcare provider before you take any supplements.
  
  
• Birth control pills: If your PMS is severe, you may be given birth control pills. Birth control pills contain hormones that can help to improve your PMS symptoms.
  
  
• Nutrition supplements: Your healthcare provider may suggest that you take calcium, magnesium, or other vitamins. These supplements may help to relieve your PMS symptoms. Talk to your healthcare provider before you take any supplements for PMS.

What lifestyle changes may help relieve PMS?

• Exercise: Exercise may decrease stress and PMS symptoms and help you feel better. Get at least 2 hours and 30 minutes or more of physical activity each week, such as walking. Get 1 hour and 15 minutes of physical activity each week if the activity requires a higher level of effort, such as running. Do muscle strengthening activities at least 2 days a week. Spread physical activity throughout the week. Talk to your healthcare provider about the best exercise plan for you.
  
  
• Get enough sleep: Most people need 6 to 8 hours. Ask your healthcare provider how many hours of sleep you should have. To help you sleep better, avoid drinks that contain alcohol or caffeine in the late afternoon or evening. Avoid nicotine (tobacco products). Do not exercise within 3 hours of going to bed.
  
  
• Do not drink alcohol: Do not have drinks that contain alcohol for 1 week before your period.
  
  
• Eat a variety of healthy foods: Healthy foods may help you feel better and have more energy. Include fruits, vegetables, whole grains, low-fat dairy products, and lean protein foods (meat, beans, and fish).
  
  
• Limit sodium: Too much sodium (salt) can cause you to retain water and increase swelling. Read labels on food and drink packages to find out how much sodium is in the food or drink. Do not eat or drink more than 2,300 milligrams (mg) of sodium each day.
  
  
• Limit caffeine: Too much caffeine can make you feel nervous or moody. Foods and drinks such as chocolate, coffee, some teas, and soda have caffeine.
  
  
• Eat less sugar: Read package labels to find out how much carbohydrates (sugars) are in the foods you eat. Sugar may be called sucrose, fructose, corn syrup, or high fructose corn syrup.

Where can I find more information?

• The National Women's Health Information Center
  8270 Willow Oaks Corporate Drive
  Fairfax , VA 22031
  Phone: 1- 800 - 994-9662
  Web Address: http://www.womenshealth.gov
  

• The American College of Obstetricians and Gynecologists
  P.O. Box 70620
  Washington , DC 20024-9998
  Phone: 1- 202 - 638-5577
  Phone: 1- 800 - 673-8444
  Web Address: http://www.acog.org
  

When should I contact my healthcare provider?

• You feel pain in your abdomen and are shaking or have chills and a fever.
  
  
• You have symptoms that last longer than 2 weeks each month.
  
  
• You feel depressed most or all of the time.
  
  
• Your PMS symptoms cause problems in your life or relationships.
  
  
• You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

• You feel that you may hurt yourself or someone else.
  
  

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.