The ® Female Patient

What You Should Know About andout

PMS and PMDD H

any women experience • Engage in an exercise that you enjoy and one that can become a regular part of your lifestyle.

discomfort 7 to 14 days atient • Keep in mind that exercise should not be prior to menstruation. P stressful or cause discomfort. Typical symptoms of Mpremenstrual syndrome (PMS) and Nutrition premenstrual dysphoric disorder • Do not skip meals. Going long periods of time between meals contributes to cravings, (PMDD) include: irritability, fatigue, and sometimes headaches. • Bloating • Most women do better eating • Constipation smaller amounts of food. Large There is no one • Depression, sadness, crying meals often cause bloating and • Fatigue general discomfort. effective treatment • Headache • If necessary, eat a small for PMS and • Backache snack between meals to PMDD, but many • Increased hunger curb hunger. women experience • Food cravings • Do not feel anxious about • Weight gain premenstrual weight gain; it some relief of • Irritability is temporary. Most women symptoms with • Tender breasts notice that their weight changes in physical • Skin problems returns to normal a few days activity, diet, and • Poor sleep into the start of their men- • Swollen hands or feet. strual cycle. lifestyle habits.

Difficulties vary from person to person, and often, from cycle to cycle. There is no one effective treatment for PMS and PMDD, but many women experience some relief of symp- toms with changes in physical activity, diet, and lifestyle habits.

Exercise • Try to incorporate some form of physical activity into your daily routine. Although aerobic activity (eg, brisk walking, cycling, jogging, swimming, roller blading) may have a greater benefit, any type of exercise is ben- eficial. For example, walking instead of driv- ing (when possible), taking long walks with a pet, gardening, raking leaves, or practicing yoga or tai chi can be soothing. • Exercise helps alleviate constipation, fatigue, irritability, swelling, and sleep problems.

1/07 The Female Patient grants permission to reproduce this handout for the purposes of patient education. A downloadable version of this patient handout is also available at: www.femalepatient.com. PMS and PMDD

• Follow a healthy diet. Be sure to include fruits, Supplements vegetables, whole grain foods, protein-rich foods, A number of products on the market claim to and calcium-containing foods in your daily diet. provide relief for PMS and PMDD. Use com- Avoid any “diet” that restricts any of these foods. mon sense and caution before experimenting • Examples of whole grain foods are whole wheat with these supplements; some may have bread, whole grain crackers, oatmeal, shredded unexpected side effects, including interactions wheat cereal, brown rice, and whole wheat pasta. with other medications. Results of studies on • Examples of protein-rich foods are fish, seafood, the advantages of various herbs, vitamins, and eggs, chicken, turkey, beef, pork, cooked dried minerals have generally not been convincing. beans, nuts, tofu, and soy products. However, the latest news on calcium and vita- • New research has shown that min D suggests that women who consume a diet rich in calcium and vita- higher amounts of these nutrients have fewer min D (both found in milk) symptoms than those who consume very small Limiting salty may be associated with fewer amounts. The benefits and safety of both cal- foods can help symptoms. Milk, yogurt, cium and vitamin D in preventing osteoporosis with bloating, cheese, fortified soy milk, (bone weakening associated with aging) are and fortified orange juice are well known. Women who do not get enough swelling, and all good sources of calcium. of these vitamins from food sources should weight gain. Vitamin D is also found in consider taking supplements. eggs and fish, and is manu- factured in the body from Recommended amount of calcium for adult exposure to sunlight. women: • Cut back on salty foods starting a few days Ages 19 to 50 years 1,000 mg per day before your period is due. Most fast foods; Ages over 50 years 1,200 mg per day chips; pretzels; olives; pickles; pizza; pepperoni; sausage; cheese; and purchased soups, sauces, Recommended amount of vitamin D for all and gravies (homemade are generally fine) are adult women: some examples of foods high in salt. 400 to 800 IU per day • Limiting salty foods can help with bloating, swelling, and weight gain. Lifestyle Habits • Limit your caffeine intake. Cut down on cof- • Get enough rest. Sleep helps combat fatigue, fee, coffee-containing beverages, tea, and irritability, mood swings, and headaches. caffeinated soft drinks. Some women find • Work on managing stress. Although no one that less caffeine helps improve symptoms lives a stress-free life, coping with stress is related to sleep, fatigue, and irritability. very important. Use relaxation techniques, • Cut down on or avoid alcohol. Drinking deep breathing, massage, yoga, or other alcohol has an effect on all the mood-related forms of exercise to help reduce stress. If nec- symptoms and can also disrupt sleep. essary, work with a counselor or therapist to develop healthy stress-management habits. • Stress management is likely to help with Resources many of the psychological symptoms of PMS or PMDD. • The National Women’s Health Information Center http://www.womenshealth.gov/faq/pms.htm

This Patient Handout was prepared by Lynn Danford, MS, • The National Institutes of Health and the US National Library of Medicine CDE, LD, using materials from The National Women’s Health MedlinePlus Information Center; and Bertone-Johnson ER, Hankinson SE, http://medlineplus.gov/ Bendich A, Johnson SR, Willett WC, Manson JE. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med. 2005;165(11):1246-1252.

The Female Patient grants permission to reproduce this handout for the purposes of patient education. 1/07 A downloadable version of this patient handout is also available at: www.femalepatient.com.