Premenstrual Syndrome (PMS)

Characterized by varying symptoms, premenstrual syndrome (PMS) appears 7 to 14 days before menses and usually subsides with its onset. The effects of PMS range from minimal discomfort to severe, disruptive symptoms and can include nervousness, irritability, depression, and multiple somatic complaints.

PMS is a complex condition that involves physical and emotional symptoms. The latest research points to changes in brain chemicals in the time before menstruation. Although the cause isn't conclusively known, PMS can be managed with various medications and other strategies.

Researchers believe that 70% to 90% of women experience PMS at some time during their childbearing years, usually between the ages of 25 and 45.

Not all women suffer PMS. Some suffer mild to moderate symptoms for a day or two only, whereas a small number of women (about 5%) suffer severe symptoms which interfere with their quality of life at some stage during their reproductive years.

Causes

The exact cause of PMS is not known but it is believed to be a complex condition involving emotional, physical, hormonal and environmental factors. PMS occurs in the presence of a regular menstrual cycle with normal levels of hormones. It is not a state of hormonal imbalance.

The following factors may influence premenstrual symptoms:

1. Stress levels and a woman's current psychological state
2. Cultural and social environment
3. Changes in neurotransmitters (brain chemicals), particularly serotonin, which are lower in the premenstrual phase before the period in women with PMS.

Signs and symptoms

Clinical effects vary widely among patients and may include any combination of the following:

• behavioral- mild to severe personality changes, nervousness, hostility, irritability, agitation, sleep disturbances, fatigue, lethargy, and depression
• somatic - breast tenderness or swelling, abdominal tenderness or bloating, joint pain, headache, edema, diarrhea or constipation, and exacerbations of skin problems (such as acne or rashes), respiratory problems (such as asthma), or neurologic problems (such as seizures).

Diagnosis

The patient history shows typical symptoms related to the menstrual cycle. To help ensure an accurate history, the patient may be asked to record menstrual symptoms and body temperature on a calendar for 2 to 3 months before diagnosis.

Estrogen and progesterone blood levels may be evaluated to help rule out hormonal imbalance. A psychological evaluation is also recommended to rule out or detect an underlying psychiatric disorder.

Treatment

Education and reassurance that PMS is a real physiologic syndrome are important parts of treatment. Because treatment is predominantly symptomatic, each patient must learn to cope with her own individual set of symptoms.

Treatment may include diuretics, antidepressants, vitamins such as B complex, progestins, prostaglandin inhibitors, and nonsteroidal anti-inflammatory drugs. For effective treatment, the patient may have to maintain a diet that's low in simple sugars, caffeine, and salt.

Natural Therapies

Many women feel they benefit from a variety of natural therapies but none have been proven in controlled studies to be beneficial, their effects being no better than placebo, i.e. about 30-40% reduction in symptoms. 

Vitamin B6 (Pyridoxine) has been used to reduce emotional symptoms and fluid retention but in doses no greater than 50-100mg per day as high doses can lead to peripheral neuropathy or loss of sensation in fingers and toes.

Evening Primrose oil has been used to reduce breast tenderness in dosages up to 3000mg per day.

St John's Wort is a plant serotonin enhancer, which may reduce mood symptoms.

Prevention

For some women, making simple lifestyle changes helps to reduce the occurrence of PMS symptoms. These changes may include:

• regular exercise (3 to 5 times each week)
• a well-balanced diet
  It is generally recommended that women with PMS increase their intake of whole grains, vegetables, and fruit, while decreasing their intake of salt, sugar, caffeine, and alcohol.
• adequate sleep and rest