Premenstrual Syndrome
Also known as: PMS
What is it?
The term menstrual disorders refers to any of a
number of conditions that are related to the
menstrual cycle. Menstruation is the
shedding of the lining of the uterus (the
endometrium) each month, also referred to as the
menstrual period. Menstrual periods usually
last for five to seven days. Most women feel
some discomfort 7 to 14 days before their period
begins. However, women with premenstrual
syndrome (PMS) have a range of physical and
emotional symptoms that affect their daily
activities and relationships. A more severe
form of PMS is known as premenstrual dysphoric
disorder (PMDD) or late luteal phase dysphoric
disorder.
Who gets it?
Any female who has begun menstruating can
experience PMS, but this disorder most often
appears for the first time in a woman's mid-20s.
Around 75% of all menstruating women experience
mild to moderate PMS. There also appears to
be a genetic link to sensitivity to hormonal
changes. The most severe form of PMS is
premenstrual dysphoric disorder (PMDD), which
affects 3 to 5 percent of women in the United
States. The symptoms of PMDD tend to get
worse over time, so this disorder is most commonly
diagnosed in women in their early to mid-30s.
What causes it?
Each month, an egg is released from a hollow
area in the ovary, called a follicle. The
empty follicle produces the hormones estrogen and
progesterone to thicken the lining of the uterus
(the endometrium) in preparation for the
fertilized egg. This is called the luteal
phase. If the egg is not fertilized, then
most of the endometrium is shed and menstrual
bleeding occurs. Some women experience the
symptoms of PMS when the estrogen and progesterone
levels are at their highest, the week before their
period begins. It is believed that these
women are highly sensitive to the fluctuating
hormone levels. These hormones also appear
to interact with two brain receptorsÑserotonin,
which regulates mood, energy, and arousal, and
gamma-aminobutyric acid (GABA), which inhibits
nerve impulses. Women with PMS may also
experience symptoms because the process of
breaking down estrogen and progesterone can cause
fluid retention.
What are the symptoms?
Most women experience mild symptoms of
bloating, fatigue, breast tenderness, swelling,
headache, backache, constipation or diarrhea,
nausea, acne flare-ups, and food cravings around a
week before menstruation. However, if you
have PMS, these symptoms affect your daily
activities and relationships. The symptoms of PMS
are not just physical, but emotional and mental as
well. These additional symptoms can include
nervousness, depression, irritability, anger,
agitation, mood swings, crying spells, decrease in
sex drive, confusion, difficulty concentrating,
and forgetfulness. You may feel overwhelmed
and unable to control your feelings and reactions
to people and situations. Symptoms may
begin as much as 14 days before your menstrual
period begins, but most commonly occur 7 to 10
days before. Women with epilepsy may have more
seizures during this time, and women with diseases
such as lupus or rheumatoid arthritis may have a
flare-up of symptoms. The symptoms of PMDD
are the same as PMS, but are more severe and
usually have more serious and life-affecting
emotional symptoms.
How is it diagnosed?
To diagnose PMS and PMDD, your doctor will ask
you to keep a chart of your symptoms for at least
two menstrual cycles. Using this chart, your
doctor will look for a pattern that links your
symptoms to your menstrual cycle. Many of
the symptoms of PMS, and especially PMDD, can be
caused by other disorders, such as clinical
depression, anxiety, eating disorders, and stress
caused by abuse or serious personal conflicts, and
by diseases such as diabetes, chronic fatigue
syndrome, and anemia. Your doctor will want
to be sure of the cause of your symptoms before
deciding upon a treatment. He will ask
questions about your reproductive history,
including any pregnancy, menstruation, and
premenstrual symptoms, and your medical history,
including any chronic illnesses and medications.
Women with PMS generally have two to four symptoms
that have a mild to moderate affect on daily life
and relationships, and disappear once the
menstrual period begins. Women with PMDD
generally have at least five premenstrual
symptoms, and at least one of these is emotional.
The emotional symptom, such as depression or
irritability, has a serious affect upon the woman's
personal, professional, and social relationships.
Again, these symptoms disappear once the menstrual
period begins. There is no laboratory test
to diagnose PMS or PMDD.
What is the treatment?
Mild to moderate PMS is treated with vitamins,
diuretics, and pain relievers. Studies have
shown that vitamin E and B supplements can help
decrease breast tenderness, fatigue, and mood
swings in some women. Calcium and magnesium
supplements also have beneficial effects on
bloating, irritability, and cramping.
Consult your doctor about vitamin dosages because
a dose that is too high can be harmful.
Reducing salt intake or taking a mild diuretic
when PMS symptoms commonly begin can help reduce
or remove excess fluid that causes bloating and
swelling of the hands and feet. You may also
feel better if you reduce the amounts of caffeine
and refined sugars in your diet and participate in
some form of aerobic exercise at this time.
Cramping and headaches can be treated with
non-prescription anti-inflammatory drugs, such as
ibuprofen and naproxen. Women with severe
premenstrual headaches may require prescription
medication. More severe cases of PMS may
find relief through hormonal treatments, such as
oral contraceptives, which help reduce the
fluctuations in estrogen and progesterone levels.
However, hormonal treatments usually do not help
with PMDD, whose more serious symptoms are more
emotional. The most effective treatment of
PMS and PMDD is with antidepressant drugs that are
classified as serotonin reuptake inhibitors (SSRIs).
SSRIs work by regulating the brain's serotonin
levels, which stabilizes emotions. The most
commonly used include sertraline, fluoxetine, and
paroxetine. Your doctor may recommend taking
an antidepressant every day, or only for a portion
of your menstrual cycle. Alternative
treatments that may decrease some symptoms of PMS
include rubbing natural progesterone creams into
the skin, and eating more phytoestrogens, found in
foods such as tofu and in some herbs. Both
help to balance the levels of progesterone and
estrogen in the body. Another way to
increase serotonin levels in the brain is to eat
more carbohydrates, such as cereals or pastas.
Other herbs, such as St. John's wort, skull cap,
and kava, have properties that relieve anxiety and
irritability to various degrees. Extracts
from the chaste tree can balance levels of
estrogen and progesterone in the body, and may
relieve anxiety and depression. Consult your
doctor about dosages of herbal supplements because
large amounts can have adverse side effects.
Also notify your doctor if you are planning to
become pregnant because some treatment methods may
affect your unborn child.
Self-care tips
If you suffer from PMS or PMDD, discuss your
symptoms with your doctor to find the treatment
plan that is right for you. With treatment,
women can overcome the effects of these disorders.
You can prevent some symptoms of PMS through diet
and exercise. Limit your intake of caffeine,
sugars, and salts, which can aggravate symptoms.
If stress is a problem, try to identify the
sources of your stress and seek help to develop
strategies for dealing with these problems.
Explain your symptoms to those who are close to
you. With their help and understanding, you
can avoid situations that trigger anxiety,
irritability, and anger each month.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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