PMS

Premenstrual syndrome (PMS), also called premenstrual tension (PMT) is a collection of emotional symptoms, with or without physical symptoms, related to a woman’s menstrual cycle. While most women of child-bearing age (up to 85%) report having experienced physical symptoms related to normal ovulatory function, such as bloating or breast tenderness, medical definitions of PMS are limited to a consistent pattern of emotional and physical symptoms occurring only during the luteal phase of the menstrual cycle that are of ‘sufficient severity to interfere with some aspects of life’. In particular, emotional symptoms must be present consistently to diagnose PMS. The specific emotional and physical symptoms attributable to PMS vary from woman to woman, but each individual woman’s pattern of symptoms is predictable, occurs consistently during the ten days prior to menses, and vanishes either shortly before or shortly after the start of menstrual flow.

CAUSES

The exact causes of PMS are not fully understood. While PMS is linked to the luteal phase, measurements of sex hormone levels are within normal levels. In twin studies, the concordance of PMS is twice as high in monozygotic twins as in dizygotic twins, suggesting the possibility of some genetic component. Current thinking suspects that central-nervous-system neurotransmitter interactions with sex hormones are affected. It is thought to be linked to activity of serotonin (a neurotransmitter) in the brain.

SYMPTOMS

More than 200 different symptoms have been associated with PMS, but the three most prominent symptoms are: irritability, tension, and dysphoria (unhappiness). Common emotional and non-specific symptoms include stress, anxiety, difficulty in falling asleep (insomnia), headache, fatigue, mood swings, increased emotional sensitivity, and changes in libido. Physical symptoms associated with the menstrual cycle include bloating, abdominal cramps, constipation, swelling or tenderness in the breasts, cyclic acne, and joint or muscle pain.

TREATMENT

Many treatments have been suggested for PMS, including diet or lifestyle changes, and other supportive means. Medical interventions are primarily concerned with hormonal intervention and use of Selective Serotonin Reuptake Inhibitors (SSRIs).

=> Due to similarities in the symptoms of PMS and hypocalcemia, calcium supplementation has been studied as a potential treatment.

=> Various vitamins have been proposed to improve symptoms with mixed results. vitamin E has shown some effectiveness.

=> Supportive therapy includes evaluation, reassurance, and informational counseling, and is an important part of therapy in an attempt to help the patient regain control over her life.

=> In addition, aerobic exercise has been found in some studies to be helpful.

=> Some PMS symptoms may be relieved by leading a healthy lifestyle: Reduction of caffeine, sugar, and sodium intake and increase of fiber, and adequate rest and sleep.

=> SSRIs like fluoxetine, sertraline can be used to treat severe PMS. Women with PMS may be able to take medication only on the days when symptoms are expected to occur. Although intermittent therapy might be more acceptable to some women, this might be less effective than continuous regimens.

=> Non-steroidal anti-inflammatory drugs (NSAIDs; e.g. ibuprofen) have been used to treat pain.

Finally, mood symptoms such as emotional lability are both more consistent and more disabling than somatic symptoms such as bloating. A woman who experiences mood symptoms is likely to experience these symptoms consistently and predictably, whereas physical symptoms may come and go.