Premenstrual Syndrome (PMS)

Definition

Premenstrual syndrome (PMS) refers to various symptoms (like irritability, anxiety, emotional instability, depression, swelling, breast pain, and headaches) appearing before menstruation (the monthly periods). The symptoms appear 7 to 10 days before and usually end a few hours after the onset of menstruation. The symptoms and the severity may vary from one woman to another. Symptoms of premenstrual syndrome tend to recur in a predictable pattern, however, in the same patient the symptoms may be particularly intense in some months while just noticeable in others.

Premenstrual syndrome most commonly affects females in their late 20s and early 30s. Most of the symptoms of premenstrual syndrome are manageable and the condition is not debilitating.

Symptoms

The most common symptoms linked with premenstrual syndrome can be grouped in the mental/emotional or physical.

Emotional and behavioral symptoms

  • Tension or anxiousness
  • Depression
  • Feeling lethargic
  • Mood swings
  • Increased irritability or anger
  • Change in appetite and food cravings
  • Trouble falling asleep
  • Lack of concentration

Physical symptoms

  • Headache
  • Joint or muscle pain
  • Fatigue
  • Abdominal bloating
  • Heaviness or pressure in pelvic area
  • Backache
  • Nausea and vomiting
  • Palpitations
  • Weight gain related to fluid retention
  • Appearance of acne
  • Breast tenderness
  • Gastrointestinal symptoms (like constipation or diarrhea)

In its severe form, premenstrual syndrome can adversely affects the lives of patients and lead to depression, anger, anxiety, feelings of hopelessness, low self-esteem, irritability, difficulty concentrating, and tension. This form of PMS is known as premenstrual dysphoric disorder (PMDD) and it may originate from an underlying psychiatric disorder. It can even affect one’s academics, occupation and interpersonal relationships.

Causes

There is a fluctuation in the female hormones, estrogen and progesterone, during the menstrual cycle. It is believed abnormalities in these hormone fluctuations may contribute to the condition which in turn affects several systems in the body. Premenstrual syndrome appears to be a disturbance in several endocrine (gland-related) factors like low blood sugar levels (hypoglycemia), changes in carbohydrate metabolism, high blood prolactin levels (hyperprolactinemia), and excessive aldosterone or ADH).

Other factors affecting symptoms of premenstrual syndrome may be grouped as:

  • Cyclic changes in hormones during or before menstruation, pregnancy, and menopause.
  • Chemical changes in the brain caused by fluctuations in the levels of serotonin, resulting in premenstrual depression, fatigue, sleep problems and food cravings.
  • Emotional stress.
  • Poor eating habits like less intake of vitamins and minerals, more intake of salty foods (causing fluid retention), and drinking caffeinated beverages and alcohol.

Treatment

Treatment options for premenstrual syndrome may be grouped as:

General measures: Taking adequate rest and sleep, exercising regularly, avoiding stress, and bringing dietary changes (like increasing protein intake, decreasing sugar and caffeine, and taking vitamin B complex or Mg supplements) may help in managing the symptoms.

Medication:

  • Antidepressants may be given to some patients. Selective serotonin reuptake inhibitors or SSRIs (like fluoxetine, paroxetine, sertraline) reduce symptoms such as anxiety, fatigue, sleep problems, irratibility, and food cravings.
  • Non-steroidal anti-inflammatory drugs or NSAIDs (like ibuprofen, naproxen) can ease cramping and breast tenderness.
  • Diuretics may help in removal of excess fluid through the kidneys.
  • Oral contraceptives (like norethindrone, medroxyprogesterone) stop ovulation and stabilize hormonal fluctuations to provide relief from PMS symptoms.
  • In rare cases with very severe or refractory symptoms, low-dose estrogen/progestin (like estradiol) may be given in combination with a gonadotropin-releasing hormone agonist (like leuprolide, goserelin) at bedtime to minimize cyclic fluctuations in hormonal levels.

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