Premenstrual syndrome (PMS)

 

Premenstrual syndrome

Premenstrual syndrome (PMS) has a wide variety of signs and symptoms. It is the occurrence of cyclical somatic, psychological and emotional symptoms that occur in the luteal (premenstrual) phase of the menstrual cycle and resolve by the time menstruation ceases. Premenstrual symptoms occur in almost all women of reproductive age.

In 3–60% symptoms are severe, causing disruption to everyday life, in particular interpersonal relationships.

 

Aetiology and Causes of  premenstrual syndrome

The precise aetiology of PMS is unknown, but cyclical ovarian activity and the effects of oestradiol and progesterone on certain neurotransmitters, including fluctuations of serotonin that could trigger PMS symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.

PMS timing

PMS symptoms can begin any time after ovulation (though they typically begin in the week before your period) and last until 5. Or so days after menstruation begins.

 

Diagnostic criteria of premenstrual syndrome  

The patient is likely to complain of some or all of the following:

1. Bloating

2. Cyclical weight gain

3. Mastalgia

4. Abdominal cramps

5. Fatigue, headache

6. Depression

7. Irritability.

Treatment of premenstrual syndrome

 • Simple therapies:

 Include stress reduction, alcohol and caffeine limitation and exercise.

 • Medical treatments:

1.     COCP:

 the most effective regime appears to be bicycling or tricycling pill packets (i.e. taking two or three packets in a row without a scheduled break)

2.     Transdermal oestrogen:

 This has been shown to significantly reduce PMS symptoms, by overcoming the fluctuations of the normal cycle.

3.     GnRH analogues:

These are a very effective treatment for PMS as they turn off ovarian activity.

4.     Selective serotonin-reuptake inhibitors (SSRIs):

This group of drugs significantly improves PMS.

 • Hysterectomy with bilateral salpingo-oopherectomy:

This procedure obviously completely removes the ovarian cycle. It should only be performed if all other treatments have failed. It is essential for such patients to have a preoperative trial of GnRH analogue as a ‘test’ to ensure that switching off ovarian function (by removing the ovaries at hysterectomy) will indeed cure the problem.

• Vitamins:

 Initial studies suggest that magnesium, calcium and isoflavones and vitamin B6 may be useful in treating PMS.

• Alternative therapies:

 Initial results of St John’s Wort are promising, particularly in improving mood. Although Evening Primrose oil is commonly used, there is no evidence to support this treatment for PMS.

• Cognitive-behavioural therapy (CBT):

CBT appears to be particularly effective when combined with SSRIs.

Lifestyle and home remedies for PMS

1. Eat smaller, more-frequent meals to reduce bloating and the sensation of fullness.

2. Limit salt and salty foods to reduce bloating and fluid retention.

3. Choose foods high in complex carbohydrates, such as fruits, vegetables and whole grains.

4. Choose foods rich in calcium.