What is PMS (Premenstrual Syndrome)?
PMS (Premenstrual Syndrome) is a variety of physical and mental discomforts that appear 3 to 10 days before menstruation and disappear with the onset of menstruation. Approximately 70-80% of menstruating women experience some kind of PMS symptoms, and among them, about 5-15% experience moderate to severe symptoms that interfere with daily life.
PMS is not "all in your head" or "something to endure," but a medical condition caused by hormonal fluctuations. Improvement can be expected with appropriate treatment.
Differences between PMS, PMDD, and Dysmenorrhea
| Condition | Characteristics | Main Treatment |
|---|---|---|
| PMS | Physical and mental discomfort 3 to 10 days before menstruation (varied symptoms) | Herbal medicine, painkillers, SSRIs |
| PMDD (Premenstrual Dysphoric Disorder) | Severe mental symptoms within PMS, significantly impairing daily life | SSRI (intermittent dosing) is the first-line treatment |
| Dysmenorrhea | Severe lower abdominal pain and back pain during menstruation (during menstruation, not before) | Painkillers, low-dose birth control pills (gynecology) |
* Even with similar menstrual-related discomforts, the timing and content of symptoms change the treatment approach.
Mechanism of Symptoms
It is thought that during the period from ovulation until just before the start of menstruation (luteal phase), progesterone (luteal hormone) fluctuates rapidly, disrupting the balance of neurotransmitters such as serotonin and GABA in the brain, leading to physical and mental symptoms. A characteristic feature is that hormone levels decrease and symptoms disappear when menstruation begins.
Main Symptoms of PMS
It is said that there are over 200 types of PMS symptoms, and they vary from person to person. They are broadly categorized into mental symptoms, physical symptoms, and behavioral changes.
Mental Symptoms
- Irritability / becoming easily angered
- Depression / tearfulness
- Anxiety / tension / restlessness
- Difficulty concentrating / impaired judgment
- Lack of motivation / not wanting to do anything
Physical Symptoms
- Headaches (migraines may worsen)
- Lower abdominal pain / back pain / joint pain
- Breast tenderness / pain
- Swelling (weight gain of 1-2 kg)
- Fatigue / easy tiredness
- Skin irritation / acne / constipation / diarrhea
- Drowsiness or insomnia
- Changes in appetite (overeating or loss of appetite) / craving for sweets
Behavioral Changes
- Clashing with family or colleagues over minor things
- Decline in work or academic performance
- Reluctance to go out, not wanting to meet people
Conditions with Symptoms Similar to PMS (Differential Diagnosis is Important)
Because PMS symptoms are varied, it is not uncommon for another underlying physical illness to be present. It is important to rule out the following conditions from an internal medicine perspective:
| Disease | Symptoms Similar to PMS | Tests to Confirm |
|---|---|---|
| Iron deficiency anemia | Fatigue, headache, difficulty concentrating | Complete blood count, ferritin |
| Thyroid dysfunction | Irritability, palpitations, swelling, depression | TSH, FT3, FT4 |
| Depression | Depressed mood, lack of motivation (persists regardless of menstruation) | Interview, symptom diary |
| Migraine | Cyclic headaches | Interview (confirmation of menstrual correlation) |
| Functional hypoglycemia | Irritability, tremors, palpitations when hungry | HbA1c, blood glucose test |
| Vitamin D deficiency | Fatigue, depressed mood | 25-OH Vitamin D |
When to Consult Us
If symptoms cannot be managed with self-care, seek help early
PMS is a condition where symptoms often significantly improve with appropriate treatment. Please don't give up and think "it's just something that happens every month"; feel free to consult us.
- Monthly symptoms interfere with work, studies, or household chores
- Family or partner relationships are affected
- Severe depression, hopelessness, or suicidal ideation occurs before menstruation (possible PMDD)
- Over-the-counter medications cannot control pain or symptoms
- Symptoms persist regardless of the menstrual cycle (possibility of another condition)
- Menstrual flow is abnormally heavy or long (possible anemia)
- Symptoms have worsened after the late 30s
Examinations and Tests at Our Clinic
Key Points for Medical Interview
If you organize the following information before your visit, the diagnosis will be smoother. If possible, please bring 2-3 months of symptom records (screenshots from an app are acceptable).
- Type and severity of symptoms
- When symptoms begin (how many days before menstruation)
- When symptoms disappear
- Impact on daily life and work
- Regularity of menstrual cycle, menstrual flow
- Current medications and supplements
Items to Check with Blood Tests
| Item | Content to Confirm |
|---|---|
| Complete Blood Count, Ferritin | Presence of anemia/iron deficiency (especially important for those with heavy menstrual flow) |
| Thyroid Function (TSH, FT4) | Exclusion of Graves' disease/Hashimoto's disease |
| Vitamin D, B12 | Exclusion of fatigue/mood symptoms due to deficiency |
| Blood Glucose, HbA1c | Exclusion of diabetes/hypoglycemic symptoms |
| Liver and Kidney Function | Safety evaluation for drug therapy |
Treatment Options
At our clinic, we will propose a combination of multiple treatment options tailored to your symptom type and severity.
Herbal Medicine (Often the First Choice)
| Prescription Name | Suitable Symptoms/Constitution |
|---|---|
| Kamishoyosan | Irritability, insomnia, cold sensitivity, hot flashes |
| Keishibukuryogan | Hot flashes, lower abdominal pain, stiff shoulders (Oketsu constitution) |
| Tokishakuyakusan | Cold sensitivity, swelling, fatigue (weak constitution) |
| Yokukansan | Irritability, anger, insomnia |
| Nyoshinsan | Hot flashes, dizziness, anxiety (menopausal-like symptoms) |
Many patients experience the effects of herbal medicine within 1-2 cycles (1-2 months), and we evaluate its effectiveness after 2-3 months of continued use. Side effects are relatively few, and long-term use is possible.
SSRI (Effective for PMDD and Severe Mental Symptoms)
If mental symptoms are particularly strong (PMDD), SSRI (Selective Serotonin Reuptake Inhibitor) is effective.
- Representative drugs: Escitalopram, Sertraline, Fluvoxamine, etc.
- Intermittent dosing (luteal phase dosing) is possible for PMS: taken only for about 2 weeks from ovulation until the start of menstruation
- Unlike depression treatment, effects appear quickly (several days to 1 week)
- Daily continuous dosing is also an option (if mental symptoms persist regardless of the menstrual cycle)
Painkillers / Symptomatic Treatment
- Headache / abdominal pain: NSAIDs (loxoprofen, ibuprofen)
- Swelling: Herbal medicines such as Tokishakuyakusan, restriction of salt and caffeine
- Insomnia: Regulation of sleep rhythm, short-term sleeping pills if necessary
Regarding Low-Dose Birth Control Pills (OC/LEP)
If you desire low-dose birth control pills
Low-dose birth control pills are very effective for PMS, PMDD, and dysmenorrhea, but a gynecological examination (medical interview, blood pressure measurement, internal examination or ultrasound) is recommended for prescription. If desired, we can refer you to a gynecologist. Co-treatment at our clinic is also possible.
Self-Care in Daily Life
Diet
- Limit caffeine (aggravates headaches and anxiety)
- Limit alcohol (exacerbates mood instability)
- Reduce salt intake (for swelling)
- Eat meals that stabilize blood sugar (avoid excessive intake of refined sugars and white rice)
- Foods containing magnesium and vitamin B6 (nuts, bananas, green and yellow vegetables)
- Soy isoflavones (miso, tofu, natto)
Exercise / Rest
- Aerobic exercise (3 times a week or more, 20-30 minutes per session): Promotes serotonin secretion
- Quality sleep (around 7 hours)
- Stress management (yoga, meditation, mindfulness)
Symptom Tracking Habit
By recording your menstrual cycle and symptoms, you can understand your own patterns, which also helps with medication adjustments. Smartphone menstrual tracking apps are convenient.
Characteristics of PMS Treatment at Our Clinic
- Comprehensive evaluation including physical illnesses by an internist
- Individualized treatment combining herbal medicines, SSRIs, and painkillers
- Blood tests for underlying conditions such as anemia, thyroid, and vitamins are also available
- Intermittent dosing of SSRIs is also available (effective for PMDD)
- If low-dose birth control pills are needed, we will refer you to a gynecologist
- No appointment necessary, same-day visits OK / Open 9:00-21:00 daily / 1 minute walk from Jujo Station
For first-time visitors
Many people hesitate, wondering if their symptoms are severe enough to warrant a visit. Because PMS is a recurring monthly symptom, early intervention can significantly improve quality of life. Please feel free to consult us first.
