Symptoms

Nearly every woman at some point has some symptoms as menstruation approaches. For about half of these women, symptoms are mild and do not affect normal daily life. The other half report symptoms severe enough to impair daily life and relationships. Between 3 - 5% of women report extremely severe symptoms.

In general, premenstrual syndrome (PMS) is a set of physical, emotional, and behavioral symptoms that occur during the last week of the luteal phase (1 -2 weeks before menstruation) in most cycles. The symptoms typically go away within 4 days after bleeding starts and do not start again until at least day 13 in the cycle. Women may begin to experience premenstrual syndrome symptoms at any time during their reproductive years. Once established, the symptoms tend to remain fairly constant until menopause, although they can vary from cycle to cycle. About 100 symptoms have been identified with the premenstrual phase.

text continues below

Physical Symptoms

Breast engorgement and tenderness
Abdominal bloating
Constipation or diarrhea
Acne
Headache and migraine (migraine may increase severity of PMS symptoms)
Alcohol intolerance
Fluid retention
Weight gain
Clumsiness
Nausea and vomiting
Heart palpitations (rapid heartbeats).

Breast Pain (Cyclical Mastalgia)

In one survey, 68% of women experienced breast symptoms associated with menstruation. According to studies, between 8 - 22% of women experience breast pain that is moderate to severe, a condition called cyclical mastalgia (also called cyclic mastopathy). (Some women experience breast pain that is unrelated to menstruation and is referred to as noncyclical mastalgia.)

This condition occurs after ovulation, increasing in intensity during the premenstrual phase and then receding at menstruation. It is often associated with PMS, but studies report that most women with this disorder do not have PMS. Some experts believe that this condition may be a unique chronic pain syndrome and require treatments that are different from those of PMS. A 2003 study suggested that women with mastalgia, both cyclical and noncyclical, may have wider milk ducts than others. The wider the duct, the more severe and persistent the pain.

Managing Cyclical Mastalgia

Lifestyle approaches for relieving cyclical mastalgia include:

Wear support bras
Reduce caffeine
Quit smoking
Over-the-counter pain relievers such as ibuprofen
Some women have noted benefit from supplements such as vitamin E, primrose oil, or flaxseed oil

Severe cases may require prescription drugs such as bromocriptine (Parlodel), danazol (Danocrine), or tamoxifen (Nolvadex). Researchers are also investigating the breast cancer drug toremifene (Fareston) for treatment of premenstrual breast pain. However, these drugs all have severe side effects, and lifestyle measures should be tried first.

Breast Cancer Fears

Many women with cyclic mastalgia are worried about an increased risk for breast cancer. It is not yet known if such concern is warranted. One study found that women with cyclical mastalgia had a greater incidence of abnormal breast cells than those without severe premenstrual breast pain. More research is still needed to confirm any increased risk for breast cancer. These women are more likely to have mammograms at an early age than others, although mammograms are not generally useful in detecting breast cancer in women younger than 35.