Irritable, hostile, or aggressive behavior, with outbursts of anger toward self or others
Loss of sex drive (may increase in some women)
Poor self-image, feelings of guilt, or increased fears
Sleep problems (sleeping too much or too little)
Exams and Tests
There are no specific signs or lab tests that can diagnose PMS. To rule out other possible causes of symptoms, it is important to have a:
Complete medical history
Physical exam (including pelvic exam)
A symptom calendar can help women identify the most troublesome symptoms and confirm the diagnosis of PMS.
Keep a daily diary or log for at least 3 months. Record the type of symptoms you have, how severe they are, and how long they last. This symptom diary will help you and your health care provider find the best treatment.
Birth control pills may decrease or increase PMS symptoms.
In severe cases, medicines to treat depression may be helpful. Antidepressants known as selective serotonin reuptake inhibitors (SSRIs) are often tried first, and have been shown to be very helpful. You may also want to seek the advice of a counselor or therapist.
Other medicines that you may use include:
Anti-anxiety drugs for severe anxiety
Diuretics (may help with severe fluid retention, which causes bloating, breast tenderness, and weight gain)
Most women who are treated for PMS symptoms get good relief.
PMS symptoms may become severe enough to prevent you from functioning normally.
The suicide rate in women with depression is much higher during the second half of the menstrual cycle. Mood disorders need to be diagnosed and treated.
When to Contact a Medical Professional
Make an appointment with your health care provider if:
PMS does not go away with self treatment
Your symptoms are so severe that they limit your ability to function
You feel like you want to hurt yourself or others
Brown I, O'Brien PMS, Marjoribanks I, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2009;2:CD001396.
Cynthia D. White, MD, Fellow American College of Obstetricians and Gynecologists, Group Health Cooperative, Bellevue, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.