Premenstrual Syndrome (PMS) refers to a wide range of physical or emotional symptoms that typically occur about 5 to 11 days before a woman starts her monthly menstrual cycle. The symptoms usually stop when menstruation begins, or shortly thereafter.
Causes, incidence, and risk factors
The exact cause of PMS has not been identified. Changes in brain hormone levels may play a role, but this has not been proven. Women with premenstrual syndrome may also respond differently to these hormones. PMS may be related to social, cultural, biological, and psychological factors and the condition is estimated to affect up to 75% of women during their childbearing years.
It occurs more often in women between their late 20s and early 40s, who have at least one child, with a personal or family history of major depression and with a history of postpartum depression or an affective mood disorder. The symptoms typically get worse in a woman’s late 30s and 40s as she approaches the transition to menopause. As many as 50% to 60% of women with severe PMS have a psychiatric disorder (Premenstrual Dysphoric Syndrome).
Symptoms
PMS refers to a set of physical, behavioral, or emotional symptoms that tend to start during the second half of the menstrual cycle. It is important to keep a daily diary or log to record the type of symptoms, how severe they are, and how long they last. Women should keep this “symptom diary” for at least 3 months. It will help the gynecologist make an accurate PMS diagnosis and recommend appropriate treatment.
The most common physical symptoms include: abdominal fullness, feeling gaseous, bloating of the abdomen, breast tenderness, clumsiness, constipation or diarrhea, food cravings, headache and less tolerance for noises and lights. Other symptoms include; confusion, difficulty concentrating, fatigue, feelings of sadness or hopelessness. Feelings of tension, anxiety, or edginess, forgetfulness irritable, hostile, or aggressive behavior, with outbursts of anger toward self or others are other symptoms as well. Women could also experience loss of sex drive (may be increased in some women), mood swings, poor judgment, poor self-image, feelings of guilt, or increased fears, sleep problems (sleeping too much or too little), slow, sluggish and lethargic movement.
Signs and tests
There are no physical examination findings or lab tests specific to the diagnosis of PMS. To rule out other potential causes of symptoms, it is important to have a complete medical history, physical examination (including pelvic exam) and psychiatric evaluation (in some cases). A symptom calendar can help women identify the most troublesome symptoms and confirm the diagnosis of PMS.
Treatment
A healthy lifestyle is the first step to managing PMS. For many women with mild symptoms, lifestyle approaches are enough to control symptoms. Plenty of fluids (water or juice, not soft drinks or other beverages with caffeine) help reduce bloating, fluid retention, and other symptoms. Women should also have frequent, small meals no more than 3 hours between snacks, and avoid overeating. Doctors may recommend nutritional supplements such as vitamin B6, calcium, or magnesium. Tryptophan, which is found in dairy products, may also be helpful. The doctor may recommend a low-salt diet and avoidance of simple sugars, caffeine, and alcohol. Regular aerobic exercise throughout the month will help reduce the severity of PMS symptoms.
Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed for pains, including headache, backache, menstrual cramping, and breast tenderness. Birth control pills may decrease or increase PMS symptoms. In severe cases, antidepressants may be helpful. The first options are usually antidepressants known as selective serotonin-reuptake inhibitors (SSRIs). Cognitive behavioral therapy may be an alternative to antidepressants. In addition, light therapy may decrease the need for antidepressant medications. Diuretics may help women with severe fluid retention, which causes bloating, breast tenderness, and weight gain.
Complications
PMS symptoms may become severe enough to prevent women from functioning normally. Women with depression may have more severe symptoms during the second half of their cycle and may need to have their medication adjusted. The suicide rate in women with depression is much higher during the second half of the menstrual cycle.
Prevention
Some of the lifestyles changes often recommended for treating PMS might help prevent symptoms or keep them from getting worse. Getting regular exercise and eating a balanced diet, with increased whole grains, vegetables, fruit, and decreased or no salt, sugar, alcohol, and caffeine, may prove beneficial. Finally, your body may have different sleep needs at different times during your menstrual cycle, so it is important to get enough rest.
