What is the premenstrual syndrome and how can it be treated? #1011/14

Q: What is the premenstrual syndrome (PMS)?



Premenstrual syndrome (PMS) is a heterogeneous collection of signs and symptoms that share one common characteristic: a temporal relationship to the menstrual cycle.  PMS is the cyclic appearance of at least one symptom during the luteal phase, followed by an entirely symptom-free interval beginning a few days after the onset of menses.  ACOG diagnostic criteria for PMS include over 150 symptoms including physical symptoms of abdominal bloating, breast tenderness, headaches, extremity edema, and psychological and behavioral symptoms of anxiety, depression, confusion, social withdrawal, angry outbursts, and irritability.  Other commonly reported manifestations of PMS include fatigue, thirst, appetite changes, and crying spells. 

To be considered clinically significant, PMS symptoms must interfere with a woman’s work, lifestyle, or interpersonal relationships.  PMS can increase relationship strain, sexual dysfunction, social isolation, work absenteeism, and risk for suicide. Studies have demonstrated that PMS results in poorer self-reported mental and physical health, increased use of health services and higher health care costs for sufferers.

How may contraception alter premenstrual syndrome?

Yes, contraceptives most likely to have a beneficial effect are those that suppress ovulation and reduce the number of withdrawal bleeding episodes. Extended-cycle dosing of combined pills, vaginal contraceptive rings and Depo-Provera injections reduce the number of withdrawal bleeding episodes (and associated symptoms).

Actually, combined pills taken 21/7, 21/7, 21/7 may decrease or increase PMS symptoms. Randomized, placebo controlled, double blinded studies found that both mood disorders and physical complaints of PMDD will reduce by about 50% in women on a 3mg drospirenone pill [Yonkers Obstet Gynecol 2005].

Robert A. Hatcher MD, MPH

Emeritus Professor of Gynecology and Obstetrics

Emory University School of Medicine

Atlanta, GA

November 2, 2014, December 16, 2014


To learn more about the advantages and disadvantages of the combined pills, NuvaRings, Depo-Provera injections; go to: www.managingcontraception.com and click on Choices 2013 edition.  You can also order this wonderful new educational book from our website or by calling 404-875-5001.  Do you have your copy yet?  It is now available in English and Spanish.

Key Words:  premenstrual syndrome (PMS), Contraceptive Technology, disorders, beneficial help, suppress ovulation, withdrawal bleeding, combined pills, vaginal contraceptive rings, Depo-Provera injections, menstrual cycle, menses, abdominal bloating, breast tenderness, headaches, extremity edema, psychological symptoms, confusion, anger, crying spells, outbursts, fatigue, thirst, appetite changes, interfere, work, school, sexual dysfunction, social isolation, risk for suicide


Reference: Nelson AL, Baldwin SB. Menstrual disorders IN Hatcher RA, Trussell J, Nelson AL, Cates Jr. W, Kowal D, Policar MS. et al Contraceptive Technology 20th edition, pages 556 & 557: Ardent Media Inc. 2013


Contraceptive Technology 20th Edition

Managing Contraception 2013-2014-Skyla Edition

Choices 2013


Posted on

December 31, 2014