Premenstrual syndrome (PMS) is characterized by physical and emotional symptoms that occur in a regular cycle beginning 1-2 weeks before the onset of menstrual flow and improve when menstrual bleeding starts. These symptoms can be extremely distressing and may include:

• Irritability
• Mood swings
• Anxiety
• Depression
• Low self-esteem
• Difficulty concentrating
• Sleep problems
• Appetite changes (sugar and/or salt cravings; overeating)
• Weight gain
• Fatigue
• Bloating
• Headache
• Breast swelling and tenderness
• Palpitations
• Dizziness
• Gastrointestinal upset
• Muscle pain

Although the symptoms of PMS may vary, the most common complaints are:

• Irritability
• Backache
• Muscle pain
• Bloating

Premenstrual Dysphoric Disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS. According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), five or more of the following symptoms must be present for a diagnosis of PMDD:

• Physical symptoms, such as breast tenderness, bloating, and joint pain
• Severe depression, possibly with suicidal thoughts
• Anxiety, tension, or panic attacks
• Severe irritability and anger
• Mood swings
• Difficulty concentrating
• Fatigue
• Teariness
• Difficulty sleeping
• Feeling out of control
• Lack of interest in relationships, activities
• Food cravings or binges