Pre-Menstrual Syndrome – Symptoms and Treatment

September 26 07:49 2023 Print This Article

Pre-Menstrual Syndrome or PMS refers to a set of physical and psychological symptoms that a girl/woman undergoes in the week before and after – start of menstruation. The menstrual cycle lasts for 28 days and starts with ovulation or release of an egg by the ovaries. Throughout the cycle, there are changes in hormones released by the body. Towards the middle of this cycle (day 14), or a week later (day 21), some women start experiencing one or more symptoms that can last up to a week after menstrual bleeding (period) begins.

It is said that almost every girl or woman on the planet has experienced one or more of these symptoms at-least once in their lifetime, which is considered as normal. Therefore, its clinically considered as PMS only when:

• The symptoms interfere with daily activities in one’s professional and personal life
• The symptoms start appearing 5 days before start of the period and lasts up to 4 days after start of period
• The symptoms occur for at least 2–3 months, or 2-3 consecutive periods

PMS is fairly common and affects around 20% of women.

Symptoms

Physical symptoms

• Joint and / or muscle pain
• Headache or backache
• Fatigue in-spite of low exertion
• Weight gain caused by fluid retention
• Bloated feeling in the abdomen
• Tenderness in the breasts, swollen breasts
• Flare-ups of acne
• Constipation or diarrhea
• Intolerance to alcohol
• Menstrual cramps – which is pain in the lower abdomen
• Extreme sensitivity to light or sound
• Changes in appetite, increase in food-cravings especially sweets
• Oily skin
• Excessive hunger and binge-eating
• Swollen hands and feet

Psychological symptoms

• Tension or anxiety
• Clumsiness
• Being moody or depressed
• Crying spells and/or repeated tearfulness
• Anger, irritability and nastiness
• Insomnia (no sleep) or trouble falling asleep
• Social withdrawal
• Inability to concentrate
• Low libido or sex-drive
• Rapidly changing mood, angry or emotional outbursts
• Difficulty in remembering information
• Feel overwhelmed and out of control
• Mental fatigue and loss of focus

Some women suffer from an extreme form of PMS called Premenstrual Dysphoric Disorder or PMDD, symptoms of which are similar to the above but more severe. In addition, the person may suffer from suicidal thoughts.

Causes

There are 2 primary causes of PMS:

• Hormonal changes in the body: levels of the hormones estrogen and progesterone fluctuate rapidly during the menstrual cycle, peaking in the luteal phase (after ovulation), and declining thereafter. These fluctuations can cause most of the psychological and physical symptoms.
• Chemical changes in the brain: Norepinenephrine and serotonin are 2 neurotransmitters that regulate mood, behavior and emotions. During the menstrual cycle, when there is a drop in estrogen, it causes norepinephrine to be released. This causes a drop in levels of serotonin, acetylcholine and dopamine. This in turn leads to problems with sleep, and mood-swings.

Risk Factors

There are many factors which do not cause PMS but increase risk of the same.

• Smoking
• Stress due to professional or personal reasons
• Alcohol consumption
• Sleep deprivation and/or lack of quality-sleep
• A personal history of depression or post-partum depression (after delivery of child)
• Person had a child recently
• Bipolar disorder
• Frequently eating foods high in sugar, salt and fat
• A sedentary lifestyle or lack of regular physical activity
• A family history of PMS, bipolar disorder, depression or post-partum depression
• Age: Women in the age-group of 27 to 43 years
• Peri-menopause: Most middle-aged women who are nearing menopause experience PMS
• Reproductive health: Conditions such as endometriosis and Polycystic Ovary Syndrome (PCOS)
• Hormonal contraception: These drugs prevent ovulation and cause changes in hormone levels in the body.

Complications

• Premenstrual exacerbation: Symptoms of existing mental health-conditions like bipolar disorder or depression worsen shortly after periods begin. This means, these conditions are both risk factors for, and also worsen symptoms of – PMS
• Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Women who are already suffering from ME experience worsening symptoms right before their period. They also experience heavy menstrual-bleeding and are at the risk of an early or premature menopause.
• Irritable bowel syndrome (IBS): This is a condition that causes gas, cramping, bloating, and diarrhea at times. These symptoms get aggravated right before the periods.
• Bladder-pain syndrome: Women who suffer from this are very likely to have painful cramps during PMS.
• Other conditions: Symptoms of migraine, asthma and allergies worsen when there is PMS

Diagnosis

• Ruling out other conditions: Conditions like anemia, hypothyroidism, mental-health conditions like depression and bipolar disorder, and ME (explained above) have symptoms that are similar to that of PMS. So to rule them out and confirm genuine PMS, the gynaecologist may order blood tests, thyroid function test, etc.
• Establishing a menstrual pattern: As mentioned earlier, every girl or woman experiences one or more symptoms of PMS from time to time. To determine clinical PMS, the consulting doctors at reputable hospitals such as Kauvery Hospital, may ask the woman to keep a diary listing all PMS symptoms experienced, along with their starting and ending dates, and the dates of menstrual periods. By reviewing this information, the doctor can confirm whether clinical PMS is present or not. gynaecologists at all branches of Kauvery Hospital, including those in Tirunelveli, Salem, Hosur, Trichy, and Chennai, ensure thorough examination to rule out other possibilities before reaching a concrete diagnosis.
• History screening: The girl or woman’s personal medical history and family medical history is enquired in detail. As mentioned under risk factors, family history of several conditions increases the risk for PMS.
• Pelvic exam: Next, the doctor will rule out any gynecological conditions through a pelvic exam.

Treatment

Medication

• Antidepressants: According to gynaecologists, these treatments help reduce mood-related symptoms and generally include a class of drugs called as Selective serotonin reuptake inhibitors or SSRIs. Examples include sertraline (Zoloft), fluoxetine (Prozac) and paroxetine (Paxil, Pexeva) among others. They are the first choice of medication and are either given daily or restricted to the two weeks before menstruation begins.
• Nonsteroidal anti-inflammatory drugs: NSAIDs help relieve cramps, breast pain, swelling in the breasts, headaches and backaches. NSAIDs such as naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others) must be taken at onset of periods.
• Diuretics or water-pills: When salt intake is high and the person lives a sedentary lifestyle, fluid starts accumulating in the body leading to weight-gain. Diuretics such as Spironolactone (Aldactone) helps eliminate excess fluid from the body and relieves some of the symptoms of PMS.
• Hormonal contraceptives: While hormonal contraceptives (birth-control pills) are a risk-factor, they can also be used as a solution, and help relieve cramps, headache and body-ache due to PMS.
• Pain-killers like acetaminophen, aspirin and ibuprofen help relieve head-ache, muscle aches or cramps in the stomach.
• Supplements:
  • Calcium can relieve depression, fatigue and craving due to PMS.
  • Vitamin B6 can relieve anxiety, moodiness, forgetfulness, irritability and bloating due to PMS.
  • Magnesium can relieve migraines due to PMS
  • Polyunsaturated fatty acids (omega-3 and omega-6) can relieve cramps and some other PMS symptoms.
  • Others: Folic acid, vitamin E and vitamin D

 Lifestyle changes

 Diet

Gynaecologists also believe that diet plays a huge role in keeping one healthy and free from various ailments or conditions including PMS. While eating smaller and more-frequent meals helps reduce bloating and the fullness sensation, limiting salt or salty foods eliminates fluid retention and bloating. The diet should be rich in complex carbohydrates such as whole grains, vitamins and minerals from fresh fruits and vegetables as well as proteins from low-fat dairy and lean meat. Cut down on sugar, salt and fats. Further, the food should be rich in:

• Calcium that comes from low-fat dairy, and calcium-fortified orange juice, bread and cereals.
• Vitamin B6 that comes from lean meat such as fish and poultry, potatoes, non-citrus fruits and fortified cereals.
• Magnesium found in green leafy vegetables, whole grains, whole nuts and fortified cereals.
• Polyunsaturated fatty acids found in green leafy vegetables, fish, nuts and flaxseed.

Exercise

Indulge in cardio exercises like jogging, running, swimming, cycling or brisk walking for 30 minutes a day, five days a week. This will relieve mood swings and fatigue due to PMS.

Stress Management

Yoga, meditation, deep-breathing, a good night’s sleep, indulging in hobbies, social interaction and regular exercise help relieve or manage stress better.

Abstinence

Cutting down on alcohol, smoking and caffeine can provide a lot of relief, while quitting them altogether is even better.

Sleep

The girl/woman should get a good night’s sleep which is 8 hours or more every day. Deep-breathing exercises and progressive muscle-relaxation technique helps relieve insomnia and get high-quality sleep. They can also relieve headaches, anxiety and mood swings.

Alternate therapies

• Cognitive behavioral therapy (CBT) helps the person reframe her thinking and cope with depressing thoughts and emotions.
• Herbal remedies like ginkgo, ginger, chasteberry (Vitex agnus), evening primrose oil and St. John’s wort are being aggressively marketed as a remedy. However, there are no clinical studies to establish their effectiveness, which is why the FDA has not approved them. Their side-effects from prolonged use is also not well-known.
• Acupuncture: Some women have found relief from this.

Home remedies

• Heat wraps or heating pads kept on the abdomen help relieve cramps
• Drink a lot of fluids which relieves abdominal bloating.
• Some herbal teas, like chamomile and red raspberry leaf, may ease cramping due to PMS.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai – Alwarpet/Vadapalani 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801