What is Premenstrual Syndrome?
Premenstrual syndrome (PMS) refers to a wide array of physical and emotional symptoms that some women experience in the latter half of their menstrual cycle, usually before their period starts. These symptoms can cause considerable discomfort and can interfere with daily activities, but they typically go away within a few days once menstruation begins. Statistically, about 48% of women of childbearing age worldwide experience PMS. Of them, 20% experience severe symptoms that interrupt their everyday routine, while the remaining experience mild to moderate symptoms.
Common symptoms of PMS may include changes in appetite, weight gain, belly and back pain, headaches, breast swelling and tenderness, nausea, constipation, along with feelings of anxiety, irritability, anger, fatigue, restlessness, mood swings, and crying spells.
A more severe form of PMS, called premenstrual dysphoric disorder (PMDD), is recognized as a mental health disorder in the diagnostic guide used by mental health professionals, known as the Diagnostic and Statistical Manual for Mental Disorders (DSM-5).
There are several ways to ease these symptoms. The first approach for milder symptoms usually involves non-drug therapies. These may include regular exercise, healthy nutrition, usage of herbal remedies, engaging in cognitive behavioral therapy (a kind of talk therapy that can help manage your problems by changing the way you think and behave), accessing social support, getting enough rest, taking regular hot baths, and using vitamin supplements. If symptoms are severe, medication is often prescribed, primarily selective serotonin reuptake inhibitors (SSRIs, a type of antidepressant).
What Causes Premenstrual Syndrome?
The exact cause of premenstrual syndrome (PMS) isn’t fully understood. However, it seems to be connected to the natural hormonal changes that happen during the menstrual cycle. Some experts believe it might be due to an imbalance of hormones, like having too much estrogen and not enough progesterone.
Hormones are chemicals that your body uses to send messages and regulate different functions. Estrogen is a group of hormones that includes three major types: estrone, estradiol, and estriol. Estradiol is the strongest. The level of estrogen in your body changes during different parts of your menstrual cycle, and these changes seem to be linked to mood changes.
It’s also thought that a brain chemical called serotonin might be involved in PMS. This is because serotonin levels rise and fall during the menstrual cycle. This rise and fall is very notable on days 7 to 11 and 17 to 19. Because serotonin is linked to mood regulation, this could explain why PMS often involves mood symptoms.
Studies done on how molecules work in the body suggest that when estrogen levels drop, it triggers other brain chemicals (norepinephrine, acetylcholine, dopamine, and serotonin) to decline as well. This can lead to problems like sleeplessness, fatigue, and feelings of sadness or hopelessness, which are common symptoms of PMS and its more severe form, premenstrual dysphoric disorder (PMDD).
Researchers have also found that diet and lifestyle seem to play a role in PMS. A study done in Egypt found that women who had PMS were more likely to eat a lot of sweet foods. They also found a link between PMS and eating junk food, and drinking coffee. Another study found similar results among female university students. In this study, fast food, sugary drinks, fried foods, not exercising regularly, and poor sleep quality were all linked to having PMS. This suggests that making healthy lifestyle choices could help reduce PMS symptoms.
Risk Factors and Frequency for Premenstrual Syndrome
Nearly 80 to 90% of women show at least one symptom of premenstrual syndrome (PMS). Among these, about 2.5 to 3% of women are significantly impacted by these symptoms to the extent that their daily activities and social interactions are affected. This more severe form of PMS is known as premenstrual dysphoric disorder (PMDD).
PMS particularly affects female university students, impacting their academic performance and overall quality of life. Here is a breakdown of the prevalence of PMS among university students in different countries:
- China: 33.82%
- Ethiopia: 37%
- Taiwan: 39.9%
- Egypt: 65%
- Turkey: 72.1 – 91.8%
- Japan: 79%
These variations in the prevalence of PMS in different countries could be due to differences in genetics, diet, and lifestyle among young adult females. Community practices related to menstruation might also play a role.
Signs and Symptoms of Premenstrual Syndrome
Premenstrual syndrome (PMS) is a condition that many women experience before their periods. It can have a variety of symptoms from mild to severe. You could notice:
- Changes in appetite
- Weight gain
- Abdominal pain or discomfort
- Back pain, particularly in the lower back
- Headache
- Breast swelling and tenderness
- Nausea
- Constipation
- Anxiety, irritability, or anger
- Fatigue
- Restlessness
- Mood swings and crying
These symptoms can last for a few days to two weeks, usually peaking about two days before the menstruation starts. Alcohol consumption has been found to slightly increase the risk of PMS. Therefore, it can be useful to share your alcohol consumption habits with your healthcare provider. They can then provide advice or treatment options that may help improve your symptoms.
Testing for Premenstrual Syndrome
To diagnose Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD), we need to rule out other possible conditions that could be causing your symptoms, both physical and mental. The three things that suggest PMS or PMDD are symptoms that align with the conditions, that these symptoms only occur during the second half of your menstrual cycle (known as the luteal phase), and that they are affecting your daily life in a negative way.
If your doctor suspects you might have PMS or PMDD, you may be asked to keep a diary of your symptoms for a few months. This can help check if your symptoms change at different times in your cycle.
It’s also important for your doctor to rule out other health conditions that could be causing your symptoms. These might include things like thyroid disorders, Cushing Syndrome, and hyperprolactinemia, which are conditions that can affect your hormonal balance. So, they may order tests to check your hormone levels, which includes follicle-stimulating hormone (FSH), estradiol (E2), thyroid-stimulating hormone (TSH), prolactin, and cortisol. These tests can provide useful information for your doctor to make a more accurate diagnosis.
Treatment Options for Premenstrual Syndrome
The main goal in treating premenstrual syndrome (PMS) is to ease symptoms and minimize disruptions to your everyday life. Medications have traditionally been the first choice in PMS treatment, but recent research suggests that using medication together with non-medical treatments can be more effective.
This combined treatment approach uses medications such as painkillers (NSAIDs), mood stabilizers (SSRIs), hormone regulators (GnRH agonists), water balance regulators (spironolactone), and birth control pills. These are paired with non-pharmaceutical treatments like talking therapies, exercise, massage, light therapy, and changes to diet and nutrition. This mix of treatments has proven successful in reducing PMS symptoms.
Making changes to your lifestyle is also advisable. Regular exercise, avoidance of stress, and a good sleeping schedule, especially during your pre-period phase, can help. Eating more complex carbohydrates can also help because these boost levels of tryptophan, a chemical that’s a building block for serotonin, which helps to regulate mood.
Cognitive-behavioral therapy (CBT) is a type of talking therapy that helps you understand and change negative thought patterns and behaviors. It helps you identify these disruptive behaviors and teaches you coping strategies to improve your daily life.
The herbal extract Vitex agnus-castus is the only proven herbal medicine to help control mood swings and irritability associated with PMS.
Recent research has shown that a specific birth control pill, containing 0.02 mg of ethinyl estradiol and 3 mg of drospirenone, taken over a 24-day cycle followed by 4 hormone-free days, has shown improvements in PMS and PMDD (a severe form of PMS) symptoms.
Selective serotonin reuptake inhibitors (SSRIs) — medications typically used to treat depression — can also be used effectively to treat PMS symptoms that are mostly emotional.
What else can Premenstrual Syndrome be?
Some health issues can cause symptoms that are very similar to those of premenstrual syndrome. These include:
- Mental health disorders, such as substance abuse, depression, anxiety, chronic low mood, and panic disorder
- Anemia
- Eating disorders like anorexia and bulimia
- Women’s health conditions, such as endometriosis and painful menstrual periods
- Medical conditions like underactive thyroid
- Other factors like using oral contraceptive pills or approaching menopause
That’s why it’s crucial for a doctor to take a detailed health history and carry out a thorough physical exam to rule out these conditions when diagnosing premenstrual syndrome.
What to expect with Premenstrual Syndrome
The signs of premenstrual syndrome (PMS), often return if treatment is stopped. The only exceptions to this are after the surgical removal of the ovaries (oophorectomy) or when a woman naturally stops having her menstrual cycle (menopause).
Possible Complications When Diagnosed with Premenstrual Syndrome
If premenstrual syndrome (PMS) is not addressed, it can influence sexual health, leading to increased levels of distress about sexual activity. This could potentially result in relationship difficulties and further mental health problems. Research also indicates a link between PMS and a higher risk of suicidal tendencies in females who are sensitive to hormonal changes.
- Untreated PMS could impact sexual health
- Increased sexual distress could lead to relationship issues
- The resultant stress can further result in mental health problems
- Research links PMS and higher suicide risk in hormone-sensitive women
Preventing Premenstrual Syndrome
Premenstrual syndrome, or PMS, is a common issue that affects many women who are of childbearing age. It’s crucial for these women to understand what is happening with their bodies, so open conversations with healthcare providers can be very beneficial. These discussions should be conducted in a caring and supportive manner, with the goal of helping women understand the reasons for their symptoms.
Involving partners in these conversations can also be helpful, as it aids the patient in getting the support they need at home and can encourage them to seek treatment if necessary.
Education about reproductive health is not just beneficial for the patient, but also strengthens the relationship between patient and doctor. This knowledge makes it easier for women to talk about their symptoms and get the help they need. Family members and partners can also benefit from learning about PMS, as their support can help reduce the symptoms a patient may be experiencing.
An especially beneficial approach can be a couple-based emotional and behavioral therapy (CBT), which can improve how individuals cope with PMS symptoms, leading to better outcomes. Given the widespread nature of this issue, providing education to the public through radio, TV, or online platforms about the diagnosis and treatment of PMS can be really helpful too.
