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Pre-Menstrual Syndrome (PMS)

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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. 

 
ETIOLOGY 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:
 
Mood swings 
Anxiety and stress 
Irritability 
Dizziness 
Breast tenderness and swelling 
Acne 
Abdominal Bloating 
Tiredness/ fatigue 
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 
Stiff neck 
Headaches/migraines 
Depression 
Crying Spells 
Sadness, feelings of "fogginess" 
Difficulty concentrating 
Indecisiveness 
Forgetfulness 
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 
Mild fever 
Social withdrawal 
Allergic and infection problem may worse 
Irregular heart beats, palpitations 
Chest pains 
Swelling of ankles, feet, and hands 
Backache 
Abdominal pain 
Recurrent cold sores 
Nausea 
Constipation or diarrhea 
Decreased coordination 
Less tolerance for noises and lights 
Painful menstruation 
Confusion 
Poor judgment 
hostility, or aggressive behavior 
Increased guilt feelings 
Slow, sluggish, lethargic movement 
Decreased self-image 
Paranoia or increased fears 
Low self-esteem 
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 
Physical examination 
Psychiatric evaluation in some cases 
Mineral Analysis Test 
Blood tests to rule out other illnesses 
 

 
FEW TIPS FOR PREVENTION OF PMS:

You can manage the PMS symptoms or sometimes changes in the regular diet and lifestyle may reduce the symptoms. This plan is usually recommended first.  
 

 
DIET 

 
o Eat a well-balanced diet with increased whole grains, vegetables, fruit,
 
o Eat smaller, more frequent meals each day to reduce bloating and the sensation of fullness. It may help you to keep blood sugar at a steady level and reduce cravings. 
 
o Avoid candy, sodas, and sugary foods during the week before your period which helps to decrease bloating and swelling.
 
o Limit salt and salty foods to reduce bloating and fluid retention. 
 
o Limit caffeine it can make breast tenderness worse and increase headaches. 
 
o Avoiding caffeine, sugar, nicotine, and alcohol eases irritability and improves sleep patterns.
 
o Take the foods high in complex carbohydrates, such as fruits, vegetables and whole grains
 
o Take diet rich in of vitamins and minerals
 
o Choose foods rich in calcium 
 

 
EXERCISE 
 
o Keeping a consistent exercise program may also improve your well-being throughout the menstrual cycle.
 
o Regular daily exercise like brisk walking, cycling and swimming can help to improve overall health and alleviate symptoms such as fatigue and a depressed mood.
 
o Regular aerobic exercise also reduces stress and promotes regular sleep patterns. Regular aerobic exercise is beneficial and may reduce PMS responses because it increases production of endorphins (the body's natural painkiller), which in turn may raise the serotonin level.
 
o Physical exercise increases sympathetic tone, a condition that lowers heart rate and reduces anxiety sensations. 
 
 
REDUCE STRESS 
 
o Get plenty of sleep. The body may have different sleep requirements at different times during a woman's menstrual cycle, so it is important to get adequate rest.
 
o Practice progressive muscle relaxation or deep-breathing exercises to help reduce headaches, anxiety and trouble sleeping or insomnia. 
 
o Yoga may help.
 
Keep a record to identify the triggers and timing of your symptoms. This will allow you to intervene with strategies that may help to lessen them.
 
A warm bath, listening to music, massage therapy may help.
 

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An enlightening post. I

Haresh's picture

An enlightening post. I wasn't aware of many of them.

This would definitely help me take a better care of loved one.

Thanks Haresh for

Thanks Haresh for thecomments.PMS has a myriads of symptoms we are not aware of.Definately knowing the causes and the symptoms and supporting our loved ones during that phase is what a woman needs.Understanding her during that phase helps her to deal with PMS in a better way.

Dr Nirupama

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