Premenstrual syndrome (known as PMS) involves a variety of physical, mental, and behavioral symptoms tied to a woman’s menstrual cycle. By definition, symptoms occur during the days before a woman's period starts.
They usually go away after the first day or two of flow.
PMS is a complex health concern. Up to 80% of women experience some symptoms of PMS. Scientists cannot agree on its cause or the best way to treat PMS.
- PMS usually occurs in women in their fourth and fifth decades of life (aged 30-49 years). For a small number of women, it can be severely incapacitating. A woman who has had a hysterectomy (removal of the uterus) may still experience PMS if at least one ovary remains.
- Because many different processes may contribute to PMS, methods of treatment vary widely and can include medical and alternative approaches. Surgery is a last resort.
- As many as 3-8% of women may have a more severe condition calledpremenstrual dysphoric disorder (PMDD). PMS and PMDD are not the same. Women with PMDD become seriously depressed for a week or more before their periods. PMS is shorter, usually milder, and involves more physical symptoms. The two may occur together, or a woman may have one and not the other.
Premenstrual syndrome (PMS):
A woman with PMS will have monthly cycles of symptoms in mood, behavior, and/or physical functioning. Though bothersome, these symptoms are usually not severe enough to interrupt a normal lifestyle. Most women who experience PMS symptoms cope with symptoms at home. A few may seek medical care for very severe symptoms.
These symptoms affect the following:
- Mood - Anxiety, nervousness, mood swings, irritability, depression, forget fulness, confusion, insomnia, hostility.
- Behavior - Cravings for sweets, increased eating, crying, poor concentration, sensitivity to noise, changes in alcohol tolerance.
- Physical functions - Headache, heart pounding, fatigue, dizziness, weight gain, bloating, breast swelling and tenderness, constipation or diarrhea.
Premenstrual dysphoric disorder (PMDD):
This is a more severe condition than PMS. It is only diagnosed when symptoms are so bad that they make it hard for a woman to function normally. While the mood symptoms are similar to the mood symptoms of PMS, they are worse and cause more problems. The physical symptoms of PMS may or may not be present.
- Like PMS, the symptoms of PMDD start 7-14 days before a woman's period and go away once the period starts. Unlike PMS, PMDD can seriously affect a woman's daily activities. PMDD is diagnosed as a mental health disorder.
- A woman may have PMDD if she has 5 or more of the following symptoms during the premenstrual week and for most cycles during the past year:
- Depression (feeling despair or hopelessness, not just sadness).
- Anxiety (keyed up, on edge).
- Severe mood swings (feeling suddenly sad or extremely sensitive to rejection).
- Anger or irritability.
- Decreased interest in usual activities (work, school, friends, hobbies).
- Difficulty concentrating.
- Decreased energy.
- Appetite changes (overeating or cravings for certain foods).
- Sleep problems (can’t sleep or wake up early, or oversleeping).
- Feeling overwhelmed or out of control.
- Physical symptoms, such as bloating, breast tenderness or headaches.
- If these symptoms do not occur in sync with the menstrual cycle, the woman may have some other medical or mental health condition.
- The symptoms of PMDD end with menopause, when menstruation stops and the levels of hormones that regulate menstruation no longer rise and fall each month.
Premenstrual syndrome occurs during the luteal phase of the menstrual cycle. This phase occurs immediately after an egg is released from the ovary and lasts from day 14 through day 28 of a normal menstrual cycle (day 1 is the day your period begins).
During the luteal phase, hormones from the ovary cause the lining of the uterus to grow thick and spongy. At the same time, an egg is released from the ovary. If the egg meetssperm, it may implant in the lining of the uterus and grow.
At this time, the level of a hormone called progesterone rises in the body, while the level of another hormone, estrogen, begins to drop. The shift from estrogen to progesterone may cause some of the symptoms of PMS.
- At first, some medical professionals believed that changing progesterone levels alone could account for a woman’s mood, behavior, and physical changes during the luteal phase (or second half) of the menstrual cycle. Progesterone interacts with certain parts of the brain that deal with relaxation. Newer studies suggest that other hormones and chemical changes may also be at work.
- For example, women develop deficiencies in a part of their nervous system called theendorphin system. Endorphins are "feel good" hormones. Normal levels contribute to cheerful, happy moods and also make people less sensitive to pain (drugs such as heroin and morphine act like super endorphins).
A small amount of these "feel good" endorphins usually circulate in the body, but these levels drop during the luteal phase of the menstrual cycle. In some women, falling endorphin levels may lead tonausea, jumpiness, and various types of pain.
- Many women with premenstrual syndrome retain water. This may occur because of cycling in hormones that affect the kidneys, the organs that control the balance of water and salt in the body. Fluid overload may cause some of the symptoms of PMS, especially swelling and weight gain, and may also aggravate some negative self perceptions and thus worsen emotional symptoms at this stage of the menstrual cycle.
- Diet may also be a factor in PMS. Progesterone, which affects insulin and levels of blood sugar, may affect alcohol tolerance and trigger the craving for sweets, especially simple sweets like candy and soda, that some women notice during the premenstrual phase. Such sweet foods break down very quickly in the body, so that blood sugar first goes up and then drops down low. Episodes of low blood sugar may contribute to both crying spells and the irritability that are part of PMS. Additionally, low levels of vitamin A, vitamin B6, and vitamin E may play a role in PMS.
- Hormonal cycling also affects the level of serotonin, a brain chemical that regulates many functions, including mood and sensitivity to pain. Compared to women who do not have PMS, some women who experience PMS have lower levels of serotonin in their brains prior to their periods (low serotonin levels are commonly associated with depression. Popular antidepressant medicines such as fluoxetine [Prozac] and paroxetine [Paxil] lift depression by raising levels of serotonin in parts of the brain).
- Another theory explaining PMS involves inflammatory substances called prostaglandins. Prostaglandins are produced in the areas where PMS symptoms originate, namely, breast, brain, reproductive tract, kidney, andgastrointestinal tract. This suggests they may play a role in problems such as cramping, breast tenderness, gas, diarrhea, and constipation.
Different treatments are aimed at different causes of PMS, and different approaches may relieve some symptoms but not others. Anti-inflammatory drugs are especially helpful for cramping, bowel symptoms, breast pain and headaches.
Diuretics (water pills) help with swelling and sometimes headaches. Antianxiety drugs and antidepressants (which usually also relieve anxiety) may help with mood, irritability, and concentration.
For those women who also seek contraception, contraceptives such as pills and patches (all of which inhibit ovulation) may be of value as they reduce the hormonal variability of the natural menstrual cycle. Indeed, the progestindrospirenone (Yasmin) has been associated with a further decrease in PMS/PMDD symptoms because of its unique action as a mild diuretic, although it is not yet specifically approved for this indication. Supplements help some women as well.
You and your health care provider may need to try different medications before you find one that works for you. Medicines may not completely relieve all your symptoms, and they are not always necessary. You can often make lifestyle changes that help.
Changes in diet and exercise are usually recommended first. Eat a well-balanced diet and avoid salt, candy, sodas, and sugary foods during the week before your period. While it may also help to avoid caffeine, going on and off caffeine during the month may be difficult. You may have to cut out caffeine completely if it seems to contribute to your symptoms. Use alcohol in moderation, if at all.
Small, frequent meals during the premenstrual week may help keep blood sugar at a steady level and reduce cravings. Keeping a consistent exercise program may also improve your well-being throughout the menstrual cycle.