Making Sense of PMS

By Melody Berg, PharmD, MPH, BCPS

Premenstrual syndrome (PMS) is a set of physical and emotional symptoms that can happen to women during certain parts of their menstrual cycle due to hormone changes.  PMS symptoms usually occur 1 to 2 weeks before a period or shortly after ovulation. The symptoms can come and go and change during life. The good news is that many of the symptoms can be managed with home remedies or over-the-counter (OTC) medications. If PMS symptoms are really severe or disruptive to your daily life, it may be something called Premenstrual Dysphoric Disorder (PMDD).

What are the symptoms of PMS?
Symptoms of PMS can look and feel different for each woman but may include any of the symptoms present in the table below:

When the emotional symptoms are more severe, like difficulty sleeping, severe depression or irritability, panic attacks, difficulty focusing, or difficulty controlling any other symptoms, you may have PMDD.

What if I have PMS symptoms?
Symptoms of PMS can be managed with home remedies or OTC medications. Regular exercise, a healthy diet, and regular sleep schedule can help with mood and combat fatigue. Consider stress relievers like yoga or meditation. Heat and warm baths can help with cramping and bloating. OTC anti-inflammatories and pain relievers like ibuprofen and naproxen can help with cramping, headaches, and back pain. Some people find it helps to start taking these medications regularly 2-3 days before their period starts.

Some vitamins, minerals, and herbal supplements have also been found to help potentially with PMS symptoms. Calcium has been shown to help with fatigue, cravings, and mood changes. You can take calcium through your diet (such as dairy foods) or supplements. Vitamin B6 has been shown to help with fatigue, mood changes, memory, and bloating. Foods rich in Vitamin B6 include fish, chicken, potatoes, fruit, and some cereals. You can also take a supplement. Supplements like black cohosh and evening primrose oil have also been tried, but studies aren’t clear as to whether they actually help.

If symptoms are severe and disrupt daily life, or are consistent with PMDD, you can talk to your healthcare provider about using prescription medicines like hormonal birth control, which can help regulate hormones and alleviate most of the symptoms. Some hormonal birth control pills contain a type of progesterone that also acts as a diuretic which helps more with bloating. If you are not a candidate for hormones, your doctor may prescribe other medications like a prescription diuretic to help with bloating or antidepressant or anti-anxiety medications to help with some mood disturbances.

When should I see my doctor?
PMS symptoms last a few days and can largely be treated with home remedies and OTC medications as described above. However, if you think you have PMDD or your symptoms are severe and do not improve with the other remedies, you may want to talk to your doctor about other management and treatment recommendations.

Pharmacist Tips:

• Be sure to drink plenty of water, get plenty of sleep and eat a healthy well-balanced diet.
• Try heating pads or soaking in a bath to help with cramping, bloating and backaches.
• Take ibuprofen or naproxen with food to keep it from upsetting your stomach.

Sometimes it can help to chart your symptoms and cycle during the month to share with you healthcare provider so they can help you manage your symptoms. There are many free apps that can help you do this such as Clue, Flo, and Eve by Glow.

Summary
PMS symptoms are very common. Most symptoms can be relieved by OTC medications, home remedies or lifestyle changes. Talk to your doctor or pharmacist if your symptoms are severe.