Pre-menstrual Syndrome (PMS) is a term used to describe a varied group of physical and psychological symptoms that occurs few days or week before the menstruation or any time after ovulation and disappear almost as soon as menstrual flow starts or shortly thereafter.
Sometimes the symptoms are so severe that they interfere with their day-to-day lives. This type of PMS is called premenstrual dysphoric disorder, or PMDD.
Premenstrual syndrome involves a combination of physical, mental, and behavioral symptoms. PMS is a complex health concern. Up to 70-80% of women experience some symptoms of PMS during their childbearing years.
Etilogy of PMS:
Exactly what causes premenstrual syndrome is not known, but several factors may contribute to the condition. It is often linked with genetic factors because twins often suffer with it.
Current theory suggests that central nervous system neurotransmitter's interaction with sex hormones may be responsible for PMS. It is also linked with activity of serotonin. Research points to the changes that occur in hormone levels before menstruation begins; when the ovaries are working to make both estrogen and progesterone. Women who do not ovulate do not have PMS. It is believed that change in progesterone level is responsible for woman’s mood, behavior, and physical changes during the luteal phase (or second half) of the menstrual cycle.
All women have both female and male hormones within the natural balance of the body. However, increased levels of male hormones as well as increased levels of prolactin can result in a delayed ovulation and low levels of progesterone, leading to PMS. Cyclic changes in hormones seem to be an important cause, because signs and symptoms of premenstrual syndrome change with hormonal fluctuations and also disappear with pregnancy and menopause.
Low levels of serotonin, an important chemical produced by the brain, may in fact be the major cause of PMS responses. Serotonin helps to regulate sleep cycles and carbohydrate metabolism and influences the regulation of estrogen and progesterone. There is a theory that the common PMS response of increased appetite with cravings for carbohydrates may be caused by low serotonin levels. Insufficient amounts of serotonin may contribute to other symptoms of PMS, such as depression, fatigue, food cravings and sleep problems.
According to another theory PMS involves inflammatory substances called prostaglandins. Prostaglandins are produced in the breast, brain, reproductive tract, kidney, and gastrointestinal tract where PMS symptoms originate; which is responsible to problems such as cramping, breast tenderness, gas, diarrhea, and constipation.
Another theory explaining PMS also linked to low levels of vitamins and minerals. Other possible contributors to PMS include eating a lot of salty foods, which may cause fluid retention, and drinking alcohol and caffeinated beverages, which may cause mood and energy level disturbances.
Endorphin levels drop during the luteal phase of the menstrual cycle; which may lead to nausea, jumpiness, and various types of pain in some women. Normal levels of this hormone lead to cheerful, happy moods and also make people less sensitive to pain.
However, it may be related to social, cultural, biological, and psychological factors.
Symptoms of PMS:
There are a number of symptoms that comes under this heading, the exact symptoms and severity may vary in different cases and with every menstrual period. The most common symptoms include:
Anxiety and stress
Breast tenderness and swelling
Sex drive changes, loss of sex drive or disinterest in sex
Lack of control or impulsivity
Feel temporarily antisocial, avoiding friends and rejecting invitations
Low self-esteem, tend to have negative, sad thoughts and experience a transitory lack of enthusiasm and energy
Sadness, feelings of "fogginess"
Weight gain from Water retention
Appetite changes and food cravings for carbohydrates and sweets
Insomnia or difficulty in falling asleep
Muscular and joint pain
Unable to concentrate
Allergic and infection problem may worse
Irregular heart beats, palpitations
Swelling of ankles, feet, and hands
Recurrent cold sores
Constipation or diarrhea
Less tolerance for noises and lights
hostility, or aggressive behavior
Increased guilt feelings
Slow, sluggish, lethargic movement
Paranoia or increased fears
Although the list of potential signs and symptoms is long, most women with premenstrual syndrome experience only a few of these problems.
Diagnosis of PMS:
There is no special test to point out PMS. The following may help in making the diagnosis:
Complete history of the patient
Psychiatric evaluation in some cases
Mineral Analysis Test
Blood tests to rule out other illnesses
Conventional treatment of PMS:
Line of treatment depends upon symptoms present in PMS
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen sodium can for cramps and breast discomfort. COX-2 inhibitors are a new type of NSAID. It is longer-acting NSAID's. Administration of COX-2 inhibitor has risk of heart attacks and strokes. COX-2 inhibitors and traditional NSAIDs have risk of serious skin reactions, stroke, deep vein thrombosis, and pulmonary embolism.
Oral contraceptives for stopping ovulation and stabilize hormonal swings; Progesterone support, Gonadotropin hormone agonists in severe PMS.
Antianxiety drugs and antidepressants - may help with mood, irritability, and concentration. Anti-anxiety drugs such as Benzodiazepines or Alprazolam. Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), which include fluoxetine, paroxetine and sertraline for fatigue, food cravings and sleep problems.
Diuretics if weight gain, breast swelling, and bloating are associated with PMS. Diuretics such as Metolazone and spironolactone .
Medroxyprogesterone acetate- it temporarily stops ovulation. However, Depo-Provera may cause an increase in some signs and symptoms of PMS, such as increased appetite, weight gain, headache and depressed mood.
If psychological symptoms are present then tranquillizers or antidepressants are prescribed.
Supplements of Calcium, Magnesium, Vitamin B-6 and Vitamin E. Multivitamin and Mineral supplement programme may helpful in some cases.
In rare cases where PMS symptoms are severe and no relief with any medications or other therapies and when pregnancy is not the objective then surgical procedure involving a partial hysterectomy can be considered.