Premenstrual Syndrome (PMS)
by Bahar Mohajerani
Definition and Incidence
Premenstrual syndrome (also called premenstrual tension; PMT) is a collection of physical, psychological, and emotional symptoms that occur during the one to two weeks prior to menstruation, improve when your period starts, and disappear a few days afterwards. Between 85-97% of women of child-bearing age experience some premenstrual symptoms, it’s a normal part of the menstrual cycle. However, between 5-10% of these women will have severe enough symptoms for it to be called PMS. Some women with severe PMS, who have predominantly emotional and behavioural symptoms which interfere with their daily functioning or relationships, may have Premenstrual Dysphoric Disorder (PMDD).
Symptoms
The type and intensity of symptoms vary from woman to woman and from cycle to cycle. The symptoms usually happen at the same time in a woman’s menstrual cycle each month. The most common physical and psychological symptoms are outlined below:
Physical:
Fluid retention
Feeling ‘full’ and bloated
Transient weight gain (from fluid retention)
Swelling of breasts and breast tenderness
Headache
Pelvic heaviness or pressure
Abdominal cramps
Backache
Appetite changes and food cravings (especially for carbohydrates, sweets and salty foods)
Psychological and Emotional:
Irritability
Anxiety
Agitation
Anger
Mood Swings
Crying spells
Social Withdrawal
General feeling of being upset or emotional
Difficulty sleeping
Difficulty Concentrating
Lethargy
Depression or feeling ‘blue’
Severe fatigue
Other symptoms may include vertigo, numbness and tingling of the extremities, fainting, palpitations, increase in body temperature, joint and muscle pain, constipation, nausea, vomiting and acne. Exacerbation of existing skin disorders, respiratory (e.g. allergies, infection), or eye problems (e.g. visual disturbances) may occur.
Causes
The exact cause of PMS is not fully understood. However it is well known that hormonal changes that occur during the second half of the menstrual cycle play a major role in PMS. Previously it was thought that PMS was caused by a deficiency of the hormone progesterone, but this theory is not proven. It has been suggested thata disturbance in the equilibrium between the ovarian hormones (the estrogens and progesterone) and certain neurotransmitters (brain chemicals), particularly serotonin*, plays a major role in PMS. Furthermore, social, cultural, and psychological factors may play a role in PMS. Psychological problems or stress can exacerbate the symptoms of PMS, however they do not actually cause PMS.
Diagnosis, Prevention and Treatment
Usually, you can make the diagnosis yourself using a menstrual chart for two to three months, or you can consult your GP. The diversity of symptoms has led to many forms of treatment which address the various symptoms, ranging from self-care strategies to drug approaches, none of which has proven to be successful in all women. In other words, there is no single definite cure for PMS.
Self-care
There are a number of lifestyle changes that can be made to help alleviate the severity and discomfort of the symptoms:
- Adequate rest and sleep
- Dietary changes:
- Decreasing or eliminating sugar, saturated fat, salt, alcohol, & caffeine consumption
- Increasing consumption of fresh fruits & vegetables, complex carbohydrates, & protein
- Supplement with vitamins B6 & E, calcium, & magnesium.
- Regular exercise, in particular aerobic exercise (preferably outdoors)
- Avoid stressful or anxious situations
- Practice some form of relaxation or meditation
- For stomach cramps: taking a warm bath or putting a warm compress on your stomach will help the muscles relax.
Drug Treatments
- In addition to reducing salt intake, taking a diuretic can relieve fluid retention and the associated bloating and breast tenderness
- Non-steroidal anti-inflammatory drugs (NSAIDs; e.g. Nurofen) can help with a number of symptoms
- Selective Serotonin Reuptake Inhibitors (SSRIs), a type of antidepressant drug often used to treat depression and anxiety, can help with a number of the psychological and emotional symptoms but may have some unpleasant side effects.
- In situations where PMS is severe and significantly interfering with daily functioning, hormonal manipulation, e.g. oral contraceptive pill, may aid in the reduction or management of symptoms. However there is not convincing research evidence that these treatments work.
Alternative Treatments
A number of other treatments may also be used. Once again, whilst there is not convincing research
evidence that these treatments work, it is possible that they might help some people:
- Evening primrose oil
- Chiropractic
- Reflexology
- Acupuncture
- Yoga
Professional Help
- Cognitive Behavioural Therapy (CBT) can help with the psychological, emotional and behavioural symptoms.
- If all of the above treatments fail to alleviate symptoms and where the PMS is so severe that it significantly interferes with daily functioning, referral to a specialist may be necessary.
Some PMS Facts
PMS often increases at times of hormonal turbulence, e.g. puberty, childbirth, after miscarriage or pregnancy termination or changes in contraception.
Women who experience postnatal illness are more prone to PMS.
Women aged 30-45 years often experience most severe PMS.
PMS often affects successive generations, although a genetic predisposition has yet to be established.
PMS often makes pre-existing conditions worse.
What Can You Do?
Although in western society PMS and women who experience it are viewed negatively, premenstrual symptoms are a normal part of the menstrual cycle. If you believe you have PMS, it is helpful to know approximately when in your cycle you start experiencing the symptoms and what your unique group of symptoms are. This knowledge will help you to prepare yourself for this time and ensure that you pay special attention to your diet, exercise, and sleep. If you take care of your mind and body during this one to two week period when they are going through some changes, you may be able to reduce and effectively manage your PMS, however discomforting and painful it can be.
*Please see ADAVIC newsletter June 2007 issue for article about serotonin.
References
Merck Manual: www.merck.com/mmhe/index.html
NHS Direct Online Health Encyclopaedia: www.nhsdirect.nhs.uk/encyclopaedia
Mayoclinic.com
Medline Plus:www.nlm.nih.gov/medlineplus
