PREMENSTRUAL SYNDROME DEFINITION
Premenstrual syndrome (PMS) has a wide variety of symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression. It’s estimated that as many as 3 of every 4 menstruating women have experienced some form of premenstrual syndrome.
Symptoms tend to recur in a predictable pattern. But the physical and emotional changes you experience with premenstrual syndrome may vary from just slightly noticeable all the way to intense.
Still, you don’t have to let these problems control your life. Treatments and lifestyle adjustments can help you reduce or manage the signs and symptoms of premenstrual syndrome.
PREMENSTRUAL SYNDROME CAUSES
The exact cause of PMS is unknown, but it seems to be related to the fluctuating levels of hormones, including estrogen and progesterone, that occur in preparation for menstruation.
PREMENSTRUAL SYNDROME PATHOPHYSIOLOGY
The definitive cause of PMS is unknown. Incorrect older theories about the causes of PMS include an estrogen excess, estrogen withdrawal, progesterone deficiency, pyridoxine (vitamin B6) deficiency, alteration of glucose metabolism, and fluid-electrolyte imbalances. Current research provides some evidence supporting the following etiologies:
- Serotonin deficiency is postulated because patients who are most affected by PMS have differences in serotonin levels; the symptoms of PMS can respond to selective serotonin reuptake inhibitors (SSRIs), which increase the amount of circulating serotonin
- Magnesium and calcium deficiencies are postulated as nutritional causes of PMS; studies evaluating supplementation show improvement in physical and emotional symptoms
- Women with PMS often have an exaggerated response to normal hormonal changes; although their levels of estrogen and progesterone are similar to those of women without PMS, rapid shifts in levels of these hormones promote pronounced emotional and physical responses
- Other theories under investigation include increased endorphins, alterations in the gamma-aminobutyric acid (GABA) system, and hypoprolactinemia
- The results of a large longitudinal study carried out by Bertone-Johnson et al suggest that the experience of abuse (emotional, sexual, or physical) in early life places women at higher risk for PMS in the middle-to-late reproductive years
PREMENSTRUAL SYNDROME SYMPTOMS
The list of potential signs and symptoms for premenstrual syndrome is long, but most women only experience a few of these problems.
Emotional and behavioral symptoms
- Tension or anxiety
- Depressed mood
- Crying spells
- Mood swings and irritability or anger
- Appetite changes and food cravings
- Trouble falling asleep (insomnia)
- Social withdrawal
- Poor concentration
Physical signs and symptoms
- Joint or muscle pain
- Weight gain related to fluid retention
- Abdominal bloating
- Breast tenderness
- Acne flare-ups
- Constipation or diarrhea
For some, the physical pain and emotional stress are severe enough to affect their daily lives. Regardless of symptom severity, the signs and symptoms generally disappear within four days of the start of the menstrual period for most women.
But a small number of women with premenstrual syndrome have disabling symptoms every month. This form of PMS is called premenstrual dysphoric disorder (PMDD).
PMDD signs and symptoms include depression, mood swings, anger, anxiety, feeling overwhelmed, difficulty concentrating, irritability and tension.
PREMENSTRUAL SYNDROME DIAGNOSIS
There is no single test to diagnose PMS. However, there are some strategies your health care provider may use to help make the diagnosis, including:
- Thyroid test. Because thyroid disease is common in women of childbearing age, and some of the symptoms of PMS — such as weight gain — are similar to symptoms of thyroid disease, a test may be done to evaluate how well your thyroid is functioning. This can help to rule out a thyroid problem as a cause of your symptoms.
- PMS symptoms diary. You may be asked to keep a diary of your PMS symptoms for two or three consecutive months, when they occur, and how long they last. By doing this, you can see if your symptoms correspond to certain times in your monthly cycle. While your symptoms may vary from month to month, a trend likely will appear after tracking them for a few months.
PREMENSTRUAL SYNDROME TREATMENT
For many women, lifestyle changes can help relieve PMS symptoms. But depending on the severity of your symptoms, your doctor may prescribe one or more medications for premenstrual syndrome. The success of medications in relieving symptoms varies from woman to woman. Commonly prescribed medications for premenstrual syndrome include:
- Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) — which include fluoxetine (Prozac, Sarafem), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and others — have been successful in reducing mood symptoms. SSRIs are the first line treatment for severe PMS or PMDD. These drugs are generally taken daily. But for some women with PMS, use of antidepressants may be limited to the two weeks before menstruation begins.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Taken before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, Naprosyn, others) can ease cramping and breast discomfort.
- Diuretics. When exercise and limiting salt intake aren’t enough to reduce the weight gain, swelling and bloating of PMS, taking water pills (diuretics) can help your body shed excess fluid through your kidneys. Spironolactone (Aldactone) is a diuretic that can help ease some of the symptoms of PMS.
- Hormonal contraceptives. These prescription medications stop ovulation, which may bring relief from PMS symptoms.