A large proportion of women have symptoms suggestive of premenstrual syndrome at some time in their lives. It is estimated that as many as 3 of every 4 menstruating women have experienced some form of premenstrual syndrome. It is time to seek professional help when these symptoms severely impact their lives.
What is PMS (premenstrual syndrome)?
Each woman’s symptoms are different and can vary from month to month. Premenstrual syndrome (PMS) has a wide variety of signs and symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression. Signs and symptoms usually start about ten days prior to the onset of a menstrual period – and may vary from just slightly noticeable, all the way to extremely intense.
What causes PMS?
The exact cause of premenstrual syndrome is unknown, but several factors may contribute to the condition. The following have been suggested:
• Cyclic changes in hormones. The fact that symptoms and signs disappear during pregnancy, and during menopause, might indicate that hormonal fluctuations might play a role.
• Chemical changes in the brain. Insufficient amounts of serotonin (a brain chemical neurotransmitter) may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.
• Depression. Some women with severe premenstrual syndrome have undiagnosed depression – though depression alone does not cause all of the symptoms
What are some common signs and symptoms of PMS?
Signs and symptoms vary tremendously from one patient to another. The following are some common signs and symptoms:
• mood swings
• feeling upset, anxious or irritable
• tiredness
• bloating or abdominal (tummy) pain
• breast tenderness and engorgement
• headaches
• spotty skin or greasy hair
• Acne flare-ups
• changes in appetite and sex drive
• Trouble falling asleep (insomnia)
In some individuals 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 after the start of the menstrual period for most women. 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, and anxiety, feeling overwhelmed, difficulty concentrating, irritability and tension.
What can you do if you have PMS?
If symptoms are not too severe there are some things you can do to help relieve symptoms. These include the following:
• regular exercise
• eat a healthy, balanced diet
• get plenty of sleep – 7 to 8 hours are recommended
• try reducing your stress by doing yoga or meditation
• take painkillers such as ibuprofen or paracetamol to ease the pain
• keep a diary of your symptoms for at least 2 to 3 menstrual cycles –
You should not smoke or drink too much alcohol.
When to see your doctor?
If you have not been able to manage your premenstrual syndrome with lifestyle changes and the symptoms of PMS are affecting your health and daily activities, you should see your gynaecologist.
Diagnosis and treatment
There are no unique physical findings or lab tests to positively diagnose premenstrual syndrome. Your doctor will take a complete history and carry out a physical examination. Other medical conditions that might mimic PMS need to be excluded.
Treatment will vary from one individual to another. In addition to lifestyle changes your doctor might recommend the following:
• hormonal medicine – such as the combined contraceptive pill
• diuretics (water tablets)
• nonsteroidal anti-inflammatory drugs (NSAIDs)
• antidepressants
• cognitive behavioural therapy – a talking therapy
The success of medications in relieving symptoms varies among women. If you still get symptoms after trying these treatments, you may be referred to other specialists for further management.
Conclusion
Premenstrual syndrome (PMS) is a cluster of signs and symptoms that occur in menstruating women. It affects a woman’s emotions, physical health, and behavior during certain days of the menstrual cycle, generally just before her menses. It is a very common condition and can vary in intensity. If signs and symptoms affect some aspect of a woman’s life she should seek professional help.
Ask Your Dr is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG is an obstetrician/Gynaecologist and Family Doctor with over thirty-eight years in clinical practice. Dr Brett Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 497 5828).
