Premenstrual Syndrome

What Causes Premenstrual Syndrome?

The cause of PMS is not yet known. Some scientists think it may be an extreme reaction to a natural drop in the level of the hormones estrogen and progesterone after a woman ovulates. It may also be related to levels of a neurotransmitter called serotonin, which plays a role in mood regulation.

Some factors seem to put a person at increased risk for PMS. Possible risk factors include:

• A family history of PMS or PMDD
• A family history of depression
• A personal history of anxiety or depression (including postpartum depression)

Is Premenstrual Syndrome Hereditary?

Researchers have not identified a direct genetic link to PMS, but many scientists suspect that there is a genetic component to risk for the disorders. Women with a family history of PMDD or PMS are more likely to have PMS. This suggests that genes play some role in the development of PMS, although other factors likely play a role in the disorder as well.

How Is Premenstrual Syndrome Detected?

Because the symptoms of PMS tend to be consistent, women are likely to be able to tell when they’re experiencing the condition. However, it can be more difficult to spot the beginning of PMDD, which may develop in women who have previously experienced PMS. In general, PMDD produces more extreme mood-related symptoms that interfere with a woman’s ability to function normally and may become life-threatening.

Some possible warning signs of PMDD include:

• Depression that manifests as extreme sadness or hopeless
• Persistent anxiety that includes feeling “on edge”
• Extreme mood swings or feeling out of control
• Suicidal thoughts

How Is Premenstrual Syndrome Diagnosed?

Diagnosis of PMS begins by ruling out medical problems that may be causing symptoms. After these exams, if the doctor suspects that PMS is the cause of the symptoms, they may recommend a psychological or psychiatric assessment.

Diagnostic steps may include:

• A physical exam. This exam aims to rule out physical conditions that could be causing the symptoms.
• Symptom diaries. Your doctor may ask you to record the details and timing of your symptoms over the course of two menstrual cycles.
• Lab tests. Your doctor may ask for laboratory tests to rule out possible medical causes of the symptoms, such as chronic fatigue syndrome or thyroid dysfunction.
• Psychological assessments. These assessments may be used to rule out PMDD if your symptoms are severe. They may take the form of questionnaires or talk sessions with a mental health professional to assess your mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Premenstrual Syndrome Treated?

PMS has no known reliable cure, but a combination of medications and lifestyle changes is often effective at reducing the severity of symptoms for many women.

Common treatment approaches include:

• Selective serotonin reuptake inhibitors (SSRIs). These drugs work by increasing the levels of serotonin, a neurotransmitter chemical in the brain. Common SSRIs include citalopram, escitalopram, fluoxetine, paroxetine, sertraline, and vilazodone.
• Hormonal birth control pills. Birth control pills help regulate hormonal levels during the menstrual cycle and may help relieve symptoms of PMDD and PMS.
• Diuretics. These medications may be used to ease fluid retention when bloating and swelling are severe and don’t respond to other treatments.
• Dietary supplements. Calcium, vitamin B-6, magnesium, and L-tryptophan may help control symptoms in some women. Consult your doctor before taking any supplements.
• Over-the-counter pain medications. These medications may help with physical symptoms such as cramps or headaches.
• Avoidance of salt and salty foods, caffeine, nicotine, and alcohol
• Improving sleep quality
• Practicing relaxation techniques such as yoga or meditation
• Getting regular exercise

How Does Premenstrual Syndrome Progress?

PMS stops when a woman enters menopause and stops having menstrual periods. However, some women find that their PMS symptoms worsen as they approach menopause. During this time, a period called perimenopause, hormonal levels fluctuate unpredictably and can trigger more intense or frequent symptoms. For most women, this period falls in their late 30s or 40s.

How Is Premenstrual Syndrome Prevented?

There is no way to prevent PMS, but prompt diagnosis and an effective treatment plan can help manage symptoms. Some scientists believe that PMS is related to depression and that hormonal changes during the menstrual cycle may worsen symptoms of pre-existing depression. If this is the case, treatment of the underlying depression may help lessen the symptoms of PMS.

Premenstrual Syndrome Caregiver Tips

Many people with PMS also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the conditions commonly associated with PMS:

• People with PMS may also suffer from anxiety.
• PMS is sometimes associated with depression.

Premenstrual Syndrome Brain Science

Although PMS is linked to the hormonal changes during a woman’s menstrual cycle, research has shown there is no difference in hormone levels between women with PMS and those without the disorder. This has led some scientists to believe that the difference lies in how the brains of women with PMS respond even to typical hormone levels.

Imaging studies have found that some women with PMS show increased activity in specific parts of their brains, including the dorsal anterior cingulate cortex (dACC) and the dorsolateral prefrontal cortex (DLPFC). The DLPFC is involved in mood regulation and conflict management, among many other cognitive functions. The role of the dACC is far less clear to neuroscientists, but it may be involved in functions such as self-control and learning.

Premenstrual Syndrome Research

Title: Comparison of Fluoxetine, Calcium, and Placebo for the Treatment of Moderate to Severe Premenstrual Syndrome (PMS)

Stage: Completed

Principal investigator: Kimberly A. Yonkers, MD

Yale School of Medicine

New Haven, CT

The purpose of this study is to compare the efficacy of calcium carbonate to fluoxetine in the treatment of moderate to severe PMS. Second, to compare each active agent to placebo control. Third, to evaluate the efficacy of each treatment for specific symptom clusters (i.e., effective and somatic). Fourth, to determine whether the addition of calcium to ongoing fluoxetine treatment leads to additional therapeutic benefits.

This is a double-blind, randomized, placebo-controlled, parallel study that will randomize 60 women at the Yale site into treatment. Participants will be screened at various collaborating ob-gyn centers for possible PMS symptoms, and direct referrals from the community will also be accepted. Subject participation length is about 7 months with 6 scheduled study visits.

Methodology: After successfully completing the screening and qualification phase, participants will be randomized to treatment at Visit 1 for 5 cycles of double-blind treatment. Participants will be evaluated monthly during the randomization phase for adverse events, concurrent medication, and primary and secondary efficacy variables.

Title: Study of Premenstrual Syndrome and Premenstrual Dysphoria

Stage: Recruiting

Principal investigator: Peter J. Schmidt, MD

National Institute of Mental Health

Bethesda, MD

This screening protocol aims to identify a population of women who experience menstrually-related mood or behavior difficulties and to describe the symptoms in this group and their relationship to the menses. This will be accomplished utilizing clinical interviews, self-rating scales, and periodic evaluation of mood and endocrine function. Researchers further wish to identify and recruit a subgroup of women with menstrually-related mood disorder for participation in specific neuroendocrine/neurophysiologic studies (companion protocols) in an attempt to identify endocrinologic or physiologic measures that might: 1) be associated with the discrete changes in mood and behavior; 2) distinguish this group from a group of age-matched controls; 3) allow for further subgroup definition based on predicted response to pharmacological intervention. Finally, we wish to identify a group of women with recurrent brief depression, who will serve as an additional control group for the patients with menstrual cycle-related mood disorders.

Women who experience PMS symptoms will complete clinical interviews, self-rating scales, and evaluations of mood and endocrine function. A subgroup of women with severe PMS (Premenstrual Dysphoric Disorder or PMDD) will be offered additional research studies that focus on 1) identifying the endocrine changes that may be responsible for changes in mood and behavior during the premenstrual period, 2) evaluating treatments for PMS symptoms, and/or 3) identifying genetic factors in women with and without PMS. Women with recurrent brief depression will also be recruited to serve as a comparison group.

Title: Premenstrual Hormonal and Affective State Evaluation (PHASE) Project (PHASE Project)

Stage: Recruiting

Principal investigator: Ajna Hamidovic, PharmD, MS

University of Illinois at Chicago

Chicago, IL

PHASE is designed to evaluate the HPA axis, heart rate, heart rate variability, and effect in women with Premenstrual Syndrome.

Healthy volunteers will be recruited from the community for participation in this 3-menstrual cycle study. In the first two menstrual cycles, study participants will chart their symptoms and use Easy@Home Ovulation strip to chart their ovulation using the PreMom app. This period will separate study participants into two groups: those with vs. without the PMS diagnosis. Study participants will continue to perform ovulation testing during their third menstrual cycle. They will attend one individualized task session and provide 8 serum samples at specific ovulation-guided menstrual cycle times.