Premenstrual syndrome

Premenstrual syndrome (PMS) is a common health problem in women in reproductive age.PMS refers to the changes in female’s mood along with certain physical symptoms relating to her menstrual cycle that are significant enough to affect her quality of life.

PMS can be clinically recognized as chronic disorder that impairs relationships, work productivity, and social activities. In a population based study 91% of the participants reported at least one symptom, 10.3% had PMS and 3.1% fulfilled the criteria for premenstrual dysphoric disorder (PMDD). Both PMS and PMDD were strongly associated with poor physical health and psychological distress*.

A cross-sectional survey in Gujarat, India among college students also showed that 91.4% participants had, at least, one premenstrual symptom of any given severity (mild to severe) in at least more than or equal to half of the menstrual cycles during last 12 months duration.
The most commonly reported symptom was “fatigue/lack of energy” (68.3%), followed by “decrease interest in work” (60.1%) and “anger/irritability” (59.9%)**.

Risk factors for PMS/PMDD include stress, genetic factors, obesity, other health problems, a history of depression or anxiety disorder, or other psychiatric disorders.  A healthy life style consisting of healthy diet and proper physical exercise is the first step to preventing and managing PMS.

References-

www.emedicinehealth.com/

* link.springer.com/article

** www.indianjpsychiatry.org

medlineplus.gov/ency

www.acog.org

Symptoms of PMS have been reported to affect as many as 90% of women of reproductive age, sometime during their lives. Symptoms occur during the two weeks before a woman's period starts, known as the luteal phase of the menstrual cycle. The symptoms typically become more intense in the two to three days prior to the period and usually resolve after the first day or two of flow. Symptoms vary from woman to woman. Symptoms may occur in the form of following changes-

  • Mood: Anxiety, nervousness, mood swings, irritability, forgetfulness, confusion, depression, insomnia.
  • Behaviour- Cravings for sweets, increased eating, crying, poor concentration, sensitivity to noise, changes in alcohol tolerance.
  • Physical- Headache, palpitations, fatigue, weight gain, bloating, breast swelling and tenderness, constipation or diarrhea, dizziness.

Premenstrual dysphoric disorder (PMDD): This is a more severe condition than PMS. While the mood symptoms are similar to the mood symptoms of PMS, they are worse and cause more problems. The physical symptoms of PMS may or may not be present.

References-

www.emedicinehealth.com

www.acog.org/Patients

 

The definitive cause of PMS is unknown, however following etiologies are postulated based on recent research such as-

  • Serotonin deficiency, because patients who are most affected by PMS have deficient serotonin levels;
  • Magnesium and calcium deficiencies, as supplementation show improvement in physical and emotional symptoms.
  • Exaggerated response to normal hormonal changes; although levels of estrogen and progesterone are similar to those of women without PMS.
  • Abuse (emotional, sexual, or physical) in early life places women at higher risk for PMS in the middle-to-late reproductive years.

Risk factors- Obesity and smoking are the risk factors for PMS. Research reveals that women with a body mass index (BMI) of 30kg/m2 or above are nearly three times as likely to have PMS as women who are not obese. Women who smoke cigarettes are likely to have more severe PMS symptoms.

PMS affects women with ovulatory cycles. Older adolescents tend to have more severe symptoms than younger adolescents do. Women in their fourth decade of life tend to be affected most severely. PMS completely resolves at menopause.

References-

emedicine.medscape.com/article/953696-overview#a3

emedicine.medscape.com/article/953696-overview#a6

emedicine.medscape.com/article/953696-overview#a7

www.ncbi.nlm.nih.gov/pubmed/25098348

Diagnosis of PMS is done clinically according to symptoms and by ruling out other conditions having similar symptoms such as depression, anxiety, peri-menopause, chronic fatigue syndrome, irritable bowel syndrome, thyroid disease. Depression and anxiety disorders are the most common conditions that overlap with PMS however; in these conditions symptoms are present all month long and may worsen before or during the periods.

Keeping a record of symptoms can help health care provider to decide about PMS.  The health care practitioner may ask the patient to keep accurate records or diary of symptoms throughout the next month or two. These records give the patient and health care professional a better understanding of the symptoms and how they relate to the patient's menstrual cycle. Some of the diagnostic signs are-

  • symptoms are present four–five days before the period for at least three menstrual cycles in a row;
  • symptoms subside with first day or two after period starts;
  • symptoms interfere with some of normal activities;
  • There are no lab tests that can confirm a diagnosis of PMS.

References-

www.emedicinehealth.com

www.acog.org/Patients

If symptoms of PMS are mild to moderate, they can be relieved by life style changes that mainly include healthy diet and exercise. Behavioral counseling and stress management may help the patients regain control during times of high emotional disturbances.

Healthy diet-Simple changes in diet may help relieve the symptoms of PMS:

  • Eat a diet rich in whole grains like whole grain bread, pasta, cereals, barley, brown rice and beans and lentils. Whole grains contain complex carbohydrates that reduce mood symptoms and food cravings.
  • Add fruits, leafy green vegetables and low fat cheese, yogurt and milk to your diet (calcium rich foods).
  • Reduce intake of fat, salt, and sugar.
  • Avoid caffeine and alcohol.
  • Eat six small meals a day rather than three large ones, or eat slightly less at three meals and add three light snacks. These modifications will keep blood sugar level stable and will help with symptoms.
  • Drink plenty of fluids (water or juice, not soft drinks, alcohol, or other beverages with caffeine).

Exercise- Exercise regularly and not just during the days that symptoms are there. At least 30 minutes of aerobic exercise most days of the week helps in reducing PMS symptoms. Aerobic exercise includes brisk walking, running, cycling, and swimming, increases heart rate and lung function. It may reduce fatigue and depression.

Relaxation techniques- Areas of stress should be identified and finding ways to relax and reduce stress can decrease the PMS symptoms. Relaxation techniques that include breathing exercises, meditation, and yoga may help in managing pre menstrual symptoms.

Getting enough sleep with regular sleeping habits is important in healthy life style modifications. Regular sleeping habits means wake up and go to sleep at the same time every day, including weekends.

Dietary supplements in the form of calcium, magnesium, vitamin E may help reduce symptoms of PMS.

Quit smoking if you smoke. 

If symptoms are so intense that interfere with the routine life, consult the doctor. In severe cases medicines may be recommended that include-

(a)  Hormonal contraceptives: these are the drugs that prevent ovulation and may be effective in relieving physical symptoms. 

(b)  Antidepressants- These drugs can help lessen mood symptoms.

(c)  Anti-anxiety drugs- If anxiety is a major PMS symptom, these drugs may be used.

(d)  Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain. Long term use of NSAIDs is not recommended.

(e)  Diuretics are drugs that help the body to lose excess water through the kidneys. These medicines have been used to reduce weight gain, breast swelling, and bloating associated with PMS.

References-

www.acog.org/Patients/FAQs

www.emedicinehealth.com

Considering the association of PMS with poor physical health and high psychological distress; PMS symptoms can be prevented with life style modifications including healthy dietary habits and exercise.

Healthy diet-Simple changes in diet may help prevent/relieve the symptoms of PMS:

  • Eat a diet rich in whole grains like whole grain bread, pasta, cereals, barley, brown rice and beans and lentils. Whole grains contain complex carbohydrates that reduce mood symptoms and food cravings.
  • Add fruits, leafy green vegetables and low fat cheese, yogurt and milk to your diet (calcium rich foods).
  • Reduce your intake of fat, salt, and sugar.
  • Avoid caffeine and alcohol.
  • Eat six small meals a day rather than three large ones, or eat slightly less at your three meals and add three light snacks. These modifications will keep blood sugar level stable and will help with symptoms.
  • Drink plenty of fluids (water or juice, not soft drinks, alcohol, or other beverages with caffeine).

Exercise- Exercise regularly (not just during the days that symptoms are present); it helps reduce pain and provides a feeling of well-being. At least 30 minutes of exercise most days of the week helps in reducing PMS symptoms. Aerobic exercise includes brisk walking, running, cycling, and swimming, increases heart rate and lung function. It may reduce fatigue and depression.

Relaxation techniques- Relaxation therapy may include breathing exercises, meditation, and yoga help to lessen PMS symptoms.

Getting enough sleep with regular sleeping habits is important. Regular sleeping habits means wake up and go to sleep at the same times every day, including weekends.

Quit smoking if you smoke.   

References-

www.acog.org/Patients

www.emedicinehealth.com

  • PUBLISHED DATE : Oct 14, 2016
  • PUBLISHED BY : Zahid
  • CREATED / VALIDATED BY : Dr. Aruna Rastogi
  • LAST UPDATED ON : Oct 14, 2016

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