iStock 000010547363SmallPremenstrual syndrome (PMS) refers to a range of physical and emotional symptoms that occur typically 5 to 11 days before the onset of menses, severe enough to affect life or work, and typically followed by a period of time entirely free of symptoms. Physical symptoms include bloating, headaches, water retention, breast tenderness, thirst and appetite changes, fatigue, lack of energy. Emotional symptoms include tension, anxiety, tearfulness, anger and irritability out of proportion to the stimulus, difficulty concentrating.

Approaches to this problem could include: (1) following a traditional medical approach of trying anti-depressants, sometimes on a cyclic basis, or (2) following estrogen and progesterone levels every few days through a typical cycle, and making adjustments in subsequent cycles as needed. Not uncommonly estrogen levels are higher than usual in the first half of the cycle, and/or that progesterone levels do not increase sufficiently in the second half. Sometimes, the second part of the menstrual cycle is abbreviated because progesterone levels do not peak high enough or last long enough.

PMS seems to increase as weight increases and insulin resistance sets in. Lifestyle management can go a long way toward reducing PMS. Since stress often exacerbates PMS, stress management approaches can be very helpful here too. Adequate hydration and nutrition, particularly B vitamins, play helpful roles as well.

Debra Ravasia, updated 2017