Premenstrual Syndrome

Premenstrual syndrome, commonly called PMS, is a medical condition that has symptoms that affect about 10 percent of women of childbearing age. PMS can cause a variety of physical and psychological symptoms that occur just before your menstrual period.

What is PMS?
It is estimated that up to 85 percent of all menstruating women do have some mild symptoms related to PMS but only about 2 - 10 percent have symptoms severe enough to be termed PMS.

Premenstrual syndrome is the name given to a group of physical and emotional symptoms that some women experience on a regular basis in relation to menstruation. The symptoms occur monthly, generally within 7 to 14 days prior to the onset of menstruation. These problems are more likely to trouble women between their late 20s and early 40s, and they tend to recur in a predictable pattern. Yet the physical and emotional changes one’s experiences with premenstrual syndrome may be particularly intense in some months and only slightly noticeable in others. The severity of PMS symptoms ranges from mild to incapacitating.

What causes PMS?
The exact cause of PMS is not known at this time. Several factors may contribute to the condition. Cyclic changes in hormones seem to be an important cause because signs and symptoms of premenstrual syndrome change with hormonal fluctuations and also disappear with pregnancy and menopause.

Chemical changes in the brain also may be involved. Fluctuations of serotonin, a brain chemical (neurotransmitter) that is thought to play a crucial role in mood states, could trigger the symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression as well as to fatigue, food cravings and sleep problems.

Some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms. Stress may also aggravate some of the symptoms, but alone it isn’t a cause.

Some PMS symptoms have been linked to low levels of vitamins and minerals. Other possible contributors to PMS include eating a lot of salty foods, which may cause fluid retention, and drinking alcohol and caffeinated beverages which may cause mood and energy level disturbances.

How do you know that you have PMS?
The most common signs and symptoms associated with premenstrual syndrome include the following:

 Tension or anxiety

 Depressed mood

 Crying spells

 Mood swings and irritability or anger

 Appetite changes and food cravings

 Trouble falling asleep (insomnia)

 Poor concentration

 Joint or muscle pain

 Headache

 Fatigue

 Weight gain from fluid retention

 Abdominal bloating

 Breast tenderness

 Acne flare-ups

 Constipation or diarrhoea

Although the list of potential signs and symptoms is long, most women with premenstrual syndrome experience only a few of these problems.

For some women, the physical pain and emotional stress are severe enough to affect their daily routines and activities. For most of these women, signs and symptoms disappear as the menstrual period begins.

But a small proportion of women with premenstrual syndrome have disabling symptoms every month. This form of PMS has its own psychiatric designation — premenstrual dysphoric disorder (PMDD). PMDD is a severe form of premenstrual syndrome with symptoms including severe depression, feelings of hopelessness, anger, anxiety, low self-esteem, difficulty concentrating, irritability and tension. A number of women with severe PMS may have an underlying psychiatric disorder.

How is PMS diagnosed?
There are no unique physical findings or laboratory tests to positively diagnose premenstrual syndrome. Your doctor may attribute a particular symptom to PMS if it’s part of your predictable premenstrual pattern. To establish a pattern, your physician may ask you to keep a record of your signs and symptoms on a calendar or in a diary for at least two menstrual cycles. Note the day that you first noticed your PMS symptoms, as well as the day they disappeared. Also be sure to mark the day your period started and ended. Alternatively, completing a questionnaire on the first day of your period, describing your symptoms during the prior two weeks, can help your doctor know whether you would benefit from further evaluation.

How is PMS treated?
Your doctor may prescribe one or more medications for premenstrual syndrome. The success of medications in relieving symptoms varies from woman to woman. Your doctor will also explain a variety of treatment options for coping with your PMS. PMS itself cannot be prevented but through education, and appropriate treatment of symptoms, most women can find relief. A healthy lifestyle including exercise, adequate rest, and a proper diet can also help a woman better manage the symptoms of PMS.

Conclusion
Premenstrual syndrome (PMS) affects many women and can cause much discomfort for the woman, her husband or partner and indeed all those close to her. The symptoms of PMS might vary from being very mild to being very severe. Fortunately, the vast majority of women with PMS can now benefit from some form of treatment.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. Dr. Brett Hodge is an obstetrician/gynaecologist and family doctor who has over twenty years in clinical practice. Dr. Hodge has a medical practice in the Johnson Building in The Valley.