Premenstrual Syndrome (PMS)

As many as 75 percent of girls and women experience unpleasant symptoms or painful pelvic cramps before or during their monthly menstrual cycle, called premenstrual syndrome (PMS).

• Some girls and women have significant PMS symptoms, but are able to forget about them after a pain reliever. For others, periods bring so much discomfort that they have to miss school or work.
• Less than an estimated 10 percent of females have symptoms so extreme they are considered disabled by the condition.
• PMS symptoms may last from a few hours to many days.
• Although PMS symptoms usually cease when menstruation starts, some girls may have PMS that lasts throughout their menstrual cycle.

There are many possible PMS symptoms. Every adolescent experiences them differently. Common symptoms include:

Psychological symptoms

• Irritability
• Nervousness
• Difficulty concentrating
• Depression
• Fatigue
• Anxiety
• Emotional hypersensitivity
• Crying spells
• Moodiness
• Sleep disturbances

Gastrointestinal symptoms

• Abdominal cramps
• Bloating
• Constipation
• Nausea
• Vomiting
• Pelvic heaviness or pressure
• Backache

Fluid retention

• Periodic weight gain
• Breast fullness and pain

Skin problems

• Acne

Other symptoms

• Headache
• Diminished sex drive
• Increased appetite and food cravings

Premenstrual syndrome seems to be related to fluctuations in estrogen and progesterone in the body during the menstrual cycle. The symptoms don't necessarily signal an ovarian condition. Suggested causes of PMS include:

• Estrogen-progesterone imbalance
• Hyperprolactinemia (an excessive secretion of prolactin, the hormone that stimulates breast development)
• Excessive aldosterone, or ADH (hormone that helps to regulate the metabolism of sodium, chloride, and potassium)
• Carbohydrate metabolism changes
• Retention of sodium and water by the kidneys
• Low blood sugar
• Allergy to progesterone
• Psychogenic factors

Diagnostic procedures for PMS are currently quite limited. A complete medical history is the most helpful in diagnosing PMS. Sometimes, a physical and pelvic examination may be needed to exclude other causes of your daughter’s discomfort.

Your daughter's physician may ask her to keep a journal of her symptoms for several months to track the timing, severity, onset, and duration of the symptoms. A psychiatric evaluation might be recommended to rule out other possible conditions.

Besides counseling with her physician and engaging in healthy habits and stress management, possible treatments of PMS include:

• Prostaglandin inhibitors (i.e., nonsteroidal anti-inflammatory medications, or NSAIDs, such as aspirin, ibuprofen), to reduce pain
• Hormonal treatments such as birth control pills
• Dietary changes
• Regular exercise
• Antidepressants (or other medications)

Simple, healthy lifestyle changes may help your daughter manage the pain and annoyance of PMS. Encourage her to:

• Exercise regularly, at least three to five times a week
• Eat a well-balanced diet, with plenty of whole grains, vegetables, and fruits
• Lower her intake of salt, sugar, caffeine, and alcohol
• Get plenty of sleep and rest

At the Division of Gynecology and Reproductive Endocrinology and PCOS Program at Boston Children's Hospital, we understand the issues that a teenage girl or young woman deals with during PMS. Our staff provides high quality treatment and counseling, especially if her symptoms are extreme and disrupt her daily activities.