Premenstrual syndrome (PMS) | Dr N Layyous

PMS (Premenstrual syndrome)

Premenstrual syndrome (PMS) is defined as physical, emotional and psychological symptoms that women may complain of after ovulation (luteal phase), typically ends with the onset of menses. A severe form of PMS occurs in a smaller number of women where they suffer severe symptoms like anxiety, irritability and anger that lead to inability to carry on with one’s daily activities and relationships. This disorder is known as premenstrual dysphoric disorder (PMDD).

Variants of Premenstrual syndrome

Progestogen-induced PMDs’ are caused by exogenous progestogens present in hormone replacement
therapy (HRT) and the combined oral contraceptive (COC) pill.

Progestogen-induced PMDs’ are caused by exogenous progestogens present in hormone replacement
therapy (HRT) and the combined oral contraceptive (COC) pill.

• Progestogen-induced, which caused by progestogens present in hormone replacement therapy (HRT) and the combined oral contraceptive pills.

Premenstrual exacerbation of an underlying diso rder’, such as diabetes, depression, epilepsy, asthma and migraine. These patients will experience symp toms relevant to their disorder throughout the menstrual Wcycle.

2. Premenstrual symptoms exaggeration, because of an underlying illness, like depression, diabetes, epilepsy, asthma and migraine. The symptoms of these diseases will be exaggerated during menses.

• Menstrual cramps are not the same as PMS although they maybe experienced together and related to ovulation and passage of blood through the cervical passage and are treated by over the counter analgesia and NSAIDs.

Prevalence of Premenstrual syndrome

About four of 10 women experience premenstrual symptoms during their lives. 5% of those have severe symptoms.

Causes of Premenstrual syndrome

Due to the wide variety of symptoms, it is difficult to give a firm diagnosis. Theories have been speculated to explain the cause of PMS. However, none of them has been proven, and specific treatment for PMS is still not well know.

There are two main theories that may explain PMS

First

Some women are sensitive to progesterone more than others.

Second

Neurotransmitters and brain receptors reactions to serotonin and GABA

(Those neurotransmitters are related to mood changes).

Symptoms experienced in Premenstrual syndrome

Psychological

• anger
• anxiety
• tension
• depression
• Crying
• Oversensitivity
• Mood swings

Physical

• Fatigue,
• Bloating (due to fluid retention),
• Weight gain
• Breast tenderness
• Acne
• Sleep disturbances
• Appetite changes with food cravings.

Diagnosis of Premenstrual syndrome

Usually the symptoms start on day of ovulation (mid cycle) and lasts from few to several days till menstrual blood flow begins then a relief period of time until ovulation of next cycle, and this can be the hallmark of diagnosis.

It is difficult to diagnose PMS and it can be a diagnosis of exclusion after having blood tests for other conditions

Conditions that mimic PMS,

• idiopathic edema
• Depression
• Chronic fatigue
• Hypothyroidism
• Irritable bowel syndrome

Another way to help make the diagnosis is to prescribe gonadotropin-releasing hormones (Decapeptyl) that stop all ovarian function. If these medications improve symptoms, then PMS is most likely the diagnosis.

Management of Premenstrual syndrome

Treatment can be challenging that the exact cause is not well known.

A healthy lifestyle:

• exercise
• emotional support
• salt restriction before the menstrual period;
• reducing caffeine intake before the menstrual period
• smoking cessation
• limiting alcohol intake
• Reducing sugar intake

Some studies showed that B6, calcium and magnesium supplements might help.

There is no solid evidence on using herbals and complementary medicine in relieving symptoms.

In severe symptoms, cognitive behavioral treatment which is a type of psychotherapy which helps the patient balancing their thoughts and behaviors and relieving mental stress.

Medical and hormonal treatments include

Combined oral contraceptive pills, Yasmin specifically

Antidepressants, specifically SSRI, either used continuously or starting mid cycle are of benefit in relieving symptoms.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist