Feeling nauseated before a period is common, and is often linked to PMS. Find out more about causes, treatments, and when to see a doctor.
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Medically reviewed by Holly Ernst, P. What causes nausea before a period? Medically reviewed by Elaine K. Luo, M. Symptoms of PMDD appear during the week before menstruation and end within a few days after your period starts.
These symptoms disrupt daily living tasks. Symptoms of PMDD are so severe that women have trouble functioning at home, at work, and in relationships during this time. This is markedly different than other times during the month. The symptoms of PMDD may look like other conditions or medical problems, such as a thyroid condition, depression, or an anxiety disorder.
Always talk with a healthcare provider for a diagnosis. Marlene Freeman. Keeping a monthly mood chart can be informative and even therapeutic for many women.
In addition to confirming the diagnosis, many women feel better if they can identify the relationship between their cycles and mood changes and can thus anticipate times at which they may be at risk for mood worsening. For women with mild symptoms, these interventions should be tried before pharmacological treatment.
Although solid evidence is lacking, clinicians generally recommend that patients with PMS or PMDD decrease or eliminate the intake of caffeine, sugar and sodium. Certain nutritional supplements have also been shown to improve premenstrual symptomatology.
A large, multicenter trial of calcium supplementation found that mg calcium a day significantly reduced both the physical and emotional symptoms of PMS. Other studies have demonstrated that Vitamin B6 in doses of mg a day can have beneficial effects in women with PMS; however, patients must be cautioned that doses above mg a day can cause peripheral neuropathy.
Limited evidence suggests that magnesium mg a day and Vitamin E IU a day can provide modest relief of symptoms. However, there is not yet enough research to recommend these as effective treatments for PMDD. Herbal remedies may have some role in the treatment of premenstrual symptoms. Though the RCTs examined had slightly different modes of chasteberry administration and outcome measures, the review found that chasteberry should be considered particularly for the alleviation of somatic PMS symptoms.
In another study, gingko biloba was found to improve PMS symptoms, particularly breast tenderness and fluid retention.
Other botanical remedies, including black cohosh, St. Light therapy has also been explored as a possible treatment for PMDD. Effect size appears to be modest for this modality, although further exploration is warranted to determine whether this may be an effective and well-tolerated option for some women.
A recent study found that cognitive-behavioral therapy CBT was as effective as fluoxetine 20 mg daily , in the treatment of women with PMDD. Selective serotonin reuptake inhibitors SSRIs are the first-line pharmacological agents for the treatment of premenstrual mood symptoms. In general, women respond to low doses of SSRIs, and this treatment response usually occurs rapidly, often within several days.
Other antidepressants with serotonergic activity have evidence to endorse their use in the treatment of premenstrual symptoms, including clomipramine a tricyclic antidepressant , 18 venlafaxine Effexor , 19 and duloxetine Cymbalta. Several dosing strategies for SSRIs may be used — continuous dosing daily throughout the month , intermittent luteal phase only dosing, and semi-intermittent dosing continuous with increased dose in the luteal phase.
While women with PMDD and no mood disorder may do well with luteal phase dosing, women who are ultimately diagnosed with a premenstrual exacerbation of a mood disorder require treatment throughout the entire menstrual cycle and typically do not respond well to intermittent dosing. Studies have also begun to examine whether beginning medication at the onset of symptoms may be effective for some women.
SSRIs may be prescribed continuously throughout the menstrual cycle, or may be given in intermittent fashion during the luteal phase of the cycle. After discontinuation of SSRI, relapse rates are relatively high. Patients who have more severe symptoms appear to have a greater chance of relapse compared to those with lower symptom severity. For the majority of women, this is a chronic condition, requiring long-term treatment.
The benzodiazepine alprazolam Xanax has been shown to have benefit in reducing premenstrual symptomatology, in particular premenstrual anxiety. However, this medication should be prescribed cautiously, given its potential for abuse and dependence. Oral contraceptive showing greater efficacy may be related to the addition of the novel progestin, drospirenone. Drospirenone is distinct from the progestins used in other oral contraceptives and is chemically related to spironolactone, a diuretic that is sometimes used to treat fluid retention in women with premenstrual symptoms.
While oral contraceptives are typically given in a cyclic manner with 21 days of active pills followed by 7 days of placebo, preliminary research suggests that continuous treatment with oral contraceptives OCP may have greater efficacy for treating PMS symptoms. The data did suggest a trend toward improvement in premenstrual DRSP scores for women with fewer lifetime depressive episodes, necessitating further studies of women with hormonal sensitivity and mood symptoms.
Weighing the risks and benefits of starting a hormonal intervention is important. Some women are not good candidates for treatment with OCPs, especially if there is a history of blood clot, stroke, or migraine.
Women who are 35 years of age or older and who smoke should not use OCPs. Additionally, women with a history of depression should speak with their doctor before taking an OCP and should remain vigilant to any mood changes that occur once they are started on an OCP treatment regime.
A recent study found that women on OCP were twice as likely to attempt or complete suicide compared to women who were not on OCP.
Gonadotropin-releasing hormone GnRH agonists, such as leuprolide, which suppress ovarian function, have been found to reduce premenstrual symptoms in most studies.
These medications, however, cause estrogen to fall to menopausal levels and are thus associated with side effects such as hot flashes and vaginal dryness, as well as increased risk of osteoporosis. Many women experience the condition every month. Symptoms vary, but generally include wildly shifting moods, profound irritability or anger, low energy, and poor sleep , which are severe enough to negatively impact usual life activities. Snyder says. An episode of PMDD can last a few days or the entire two weeks.
Once a woman menstruates and her hormones shift, she becomes herself again. But PMS, which most reproductive-age women experience, generally results in uncomfortable symptoms like bloating , appetite change, and mild irritability, Snyder says.
PMDD is officially said to affect some 5 percent of women of childbearing age, but Snyder believes the true number is higher. According to the Journal of Psychiatry study, fluctuations in ovarian hormones, especially progesterone , are believed to be behind the condition.
Although the exact mechanism by which progesterone might cause PMDD is not known, receptors for the hormone exist throughout the brain, including in the amygdala, hippocampus, prefrontal cortex, and other sections. Progesterone easily passes through the blood-brain barrier, the authors note.
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