Premenstrual syndrome (PMS)


Premenstrual syndrome is a constellation of symptoms that occurs prior to menstruation and is severe enough to interfere significantly with the patient’s life. DSM-IV-R diagnosis is premenstrual dysmorphic disorder when the dominant symptoms are emotional.

System(s) affected: Endocrine/Metabolic, Reproductive, Nervous

Genetics: Unknown, probably familial incidence

Incidence/Prevalence in USA: Almost all women have some symptoms prior to menses (this is not PMS). About 5% have actual PMS.

Predominant age: Childbearing years, increasing with years

Predominant sex: Females only

Sings and symptoms

Symptoms can involve any organ system but the following are more common:

  • Depressed mood
  • Mood swings
  • Irritability
  • Difficulty concentrating
  • Fatigue
  • Edema
  • Breast tenderness
  • Headaches
  • Sleep disturbances


Unknown, presumed hormonal; perhaps interacting with neurotransmitters

Risk Factors

  • Premenstrual exacerbations can occur with other diseases (i.e., depression)
  • Caffeine and high fluid intake exacerbate PMS symptoms
  • Stress may precipitate
  • PMS increases with age
  • History of depression
  • Tobacco use



The major differentials are psychiatric syndromes, particularly depressive disorders and/or dysthymia. Other entities may be suggested by history or physical.

There are no laboratory tests which confirm or refute PMS. History and physical may disclose a need for specific laboratory tests.

Drugs that may alter lab results: N/A

Disorders that may alter lab results: N/A

Diagnostic Procedures
Patients complete questionnaires over a minimum of two months to confirm premenstrual exacerbation of symptoms and lack of substantial symptoms in the follicular phase



General Measure

  • Increase daily exercise
  • Eat regular, balanced meals
  • Stop smoking
  • Get regular sleep
  • Stress reduction techniques
  • Cognitive behavioral therapy (may provide better long-term effect than SSRIs)
  • Support groups
  • Light therapy


  • No restrictions
  • Exercise is recommended

Low-salt; low-caffeine; low-fat; frequent, small meals; high complex carbohydrates

Patient Education
Explain PMS and treatment


Drugs of choice
No single drug works for all women. Drugs that are used with varying degrees of success are listed.

  • Antidepressants [fluoxetine (Prozac, Sarafem), sertraline, clomipramine, citalopram or nortriptyline], particularly for patients with depressive symptoms. Antidepressants can work when used only during the luteal phase of the menstrual cycle.
  • Elemental calcium 1000 mg/day
  • Diuretics (usually spironolactone) during luteal phase
  • Symptomatic treatment of pain (ibuprofen or acetaminophen)
  • Vitamin B6 in modest doses (50 mg bid, may be toxic in higher doses)
  • Vitamin E: up to 600 IU/day
  • Evening primrose oil, high content of fatty acids, 500 mg qd to 1000 mg tid for breast tenderness, believed to decrease prostaglandin synthesis
  • Oral contraceptives may help
  • Bromocriptine 2.5 mg tid at time of symptoms and danazol 100 mg bid may also work for breast tenderness, but have more side effects
  • Danazol for the total PMS symptom complex
  • Gonadotropin-releasing hormone agonists with or without concurrent estrogens/progestins
  • L-tryptophan 2 g three times a day

Contraindications: Refer to manufacturer’s profile of each drug

Precautions: Refer to manufacturer’s profile of each drug

Significant possible interactions: Refer to manufacturer’s profile of each drug

Patient Monitoring
See patient to provide general support and further patient education

Expected Cource/Prognosis
Many patients can have their symptoms adequately controlled. Disappears at menopause.


  • Premenstrual dysphoric disorder
  • PMDD

625.4 Premenstrual tension syndromes

Provided by ArmMed Media
Revision date: July 7, 2011
Last revised: by Tatiana Kuznetsova, D.M.D.