Premenstrual Syndrome


What is premenstrual syndrome?

Premenstrual syndrome (PMS) is a combination of emotional, physical, psychological, and mood disturbances that occur after a woman's ovulation and typically ending with the onset of her menstrual flow. The most common mood-related symptoms are irritability,depression, crying, oversensitivity, and mood swings with alternating sadness and anger. The most common physical symptoms are fatigue, bloating, breast tenderness(mastalgia), acne, and appetite changes with food cravings.
A more severe form of PMS, known aspremenstrual dysphoric disorder(PMDD), also known as late luteal phase dysphoric disorder) occurs in a smaller number of women and leads to significant loss of function because of unusually severe symptoms.

How common is PMS?

About 80% of women experience some premenstrual symptoms. The incidence of true PMS has often been overestimated by including all women who experience any physical or emotional symptoms prior to menstruation. It is estimated that clinically significant PMS (which is moderate to severe in intensity and affects a woman's functioning) occurs in 20% to 30% of women. About 2% to 6% of women are believed to have the more severe variant known as PMDD.

When was PMS discovered?

The mood changes surrounding this condition have been described as early as the time of the ancient Greeks. However, it was not until 1931 that this disorder was officially recognized by the medical community. The term "premenstrual syndrome" was coined in 1953.

What causes PMS?

PMS remains an enigma because of the wide-ranging symptoms and the difficulty in making a firm diagnosis. Several theories have been advanced to explain the cause of PMS. None of these theories have been proven, and specific treatment for PMS still largely lacks a solid scientific basis. Most evidence suggests that PMS results from the alterations in or interactions between the levels of sex hormones and brain chemicals known as neurotransmitters.
PMS does not appear to be specifically associated with any personality factors or specific personality types. Likewise, a number of studies have shown that psychological-stress is not related to the severity of PMS.

What are the symptoms of PMS?

A great variety of symptoms have been attributed to PMS. Women can have PMS of varying duration and severity from cycle to cycle. The most frequent mood-related symptoms of PMS include:
  • anger and irritability,

  • anxiety,

  • tension, 

  • depression,

  • crying, 

  • oversensitivity, and 

  • exaggerated mood swings.
The most frequent physical signs and symptoms of PMS include:
  • fatigue, 

  • bloating (due to fluid retention), 

  • weight gain, 

  • breast tenderness, 

  • acne,

  • sleep disturbances with sleeping too much or too little (insomnia), and 

  • appetite changes with overeating or food cravings.

How is the diagnosis of PMS made?

The most helpful diagnostic tool is the menstrual diary, which documents physical and emotional symptoms over months. If the changes occur consistently around ovulation (midcycle, or days 7-10 into the menstrual cycle) and persist until the menstrual flow begins, then PMS is probably the accurate diagnosis. Keeping a menstrual diary not only helps the healthcare provider to make the diagnosis, but it also promotes a better understanding by the patient of her own body and moods. Once the diagnosis of PMS is made and understood, the patient can better cope with the symptoms.
The diagnosis of PMS can be difficult because many medical and psychological conditions can mimic or worsen symptoms of PMS. There are no laboratory tests to determine if a woman has PMS. When laboratory tests are performed, they are used to exclude other conditions that can mimic PMS.

What conditions are like PMS?

Some examples of conditions that can mimic PMS include:
  • depression,
  • cyclic water retention (idiopathic edema), 
  • chronic fatigue,
  • hypothyroidism, and
  • irritable bowel syndrome.

How is PMS distinguished from other conditions?

The hallmark of the diagnosis of PMS is that symptom-free interval after the menstrual flow and prior to the next ovulation. If there is no such interval and the symptoms persist throughout the cycle, then PMS may not be the proper diagnosis. PMS can still be present and aggravate symptoms related to the other conditions, but it cannot be the sole cause of constant or non-cyclic symptoms. Blood or other tests may be ordered to help rule out other potential causes of symptoms.
Another way to help make the diagnosis of PMS is to prescribe drugs that stop all ovarian function. If these medications produce relief of the troublesome symptoms, then PMS is most likely the diagnosis.

What treatments are available for PMS?

The treatment of PMS can sometimes be as challenging as making the diagnosis of PMS. Various treatment approaches have been used to treat this condition. Some measures lack a solid scientific basis but seem to help some women. Other treatments with a sound scientific basis may not help all patients.
General management includes a healthy lifestyle including:
  • exercise;
  • family and friends can provide emotional support during the time of a woman's cycle;
  • avoid salt before the menstrual period;
  • reduce caffeine intake;
  • quite smoking;
  • reduce alcohol intake; and
  • reduce intake of refined sugars.
All of the above have been recommended and may help symptoms in some women. Furthermore, some studies suggest that vitamin B6, vitamin E, calcium, and magnesium supplements may have some benefit.

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