Premenstrual syndrome (PMS) affects many women and can cause much distress and suffering for the woman and those around her. The severity and intensity of symptoms may vary from one woman to the other.

What is premenstrual syndrome?
The premenstrual syndrome (PMS) consists of a set of emotional, behavioural and physical symptoms that recur regularly during the second half of each menstrual cycle, with complete absence of symptoms immediately after menstruation.
The severity of PMS symptoms ranges from mild to incapacitating. Symptoms can occur for only one day or may begin at ovulation and continue until the onset of menstruation. Unlike dysmenorrhoea, PMS does not wane with age. More than 150 symptoms of PMS have been described.

What are some of the symptoms of PMS?
Emotional and behavioural symptoms include the following:
Depression
Irritability
Anxiety
Loss of self-control
Poor concentration
Change in libido
Aggression or violence
Food cravings
Fatigue

Physical symptoms include:
Headache
Breast swelling
Breast tenderness
Backache
Weight gain
Abdominal bloating
Acne
Swollen fingers and ankles

Who experiences PMS?
PMS is estimated to affect 70% to 90% of women during their childbearing years. 30% to 40% of women are thought to have PMS symptoms severe enough to interfere with daily living activities. PMS can occur at any time in a menstruating woman’s life, but it appears more frequently in her late twenties and thirties.
What causes PMS?
An exact cause of PMS has not been identified. PMS may be related to social, cultural, biological and psychological factors. PMS can occur in women with normal functioning ovaries.

Prevention
Some lifestyle changes are useful in preventing symptoms from developing or getting worse.
Regular exercise, about 3 to 5 times per week, a balanced diet and adequate rest have been shown to be helpful.

Diagnosis
The diagnosis of PMS depends on the timing of symptoms in relation to menstruation. At this time there is no test that can definitely show that a woman has PMS. To help in making a diagnosis, a woman suspected with PMS should keep a diary for at least 2 months and then discuss the symptoms with her doctor, a chart may also prove helpful.

General management
Women with PMS should see their gynaecologist for examination and evaluation. Any underlying cause for these symptoms should be ruled out.
Support and reassurance: In many women with PMS, support and reassurance is very beneficial. Women should be reassured by their doctor that PMS does not affect fertility and their doctor should exclude any underlying illness. Exercise (e.g. walking, swimming) and stress management during the premenstrual period may also help.
Dietary advice: Maintaining steady blood glucose levels may benefit women with PMS, and changing to a 3-hourly starch diet may help relieve symptoms, while carefully avoiding weight gain. Women have used pyridoxine (vitaminB6) for many years in doses of 50-300mg per day. Excessive doses should be avoided as they can cause nerve damage.
Drug treatment: A number of drugs have been used in the treatment of symptoms of PMS. Your doctor should explain the pros and cons of using the various drugs available.
There is no one treatment for PMS because the exact cause of this condition is not known. Psychological counseling may be needed in some patients in conjunction with medical treatments.

Conclusion
PMS is very common and in some women the symptoms are so severe that they disrupt day-to-day activity and interfere with relationships. Women with severe symptoms should see their doctor for a complete evaluation and treatment. In some patients, a multidimensional approach may be needed to provide the best way of treating the patient successfully.

Dr Brett Hodge is a Family Physician and Specialist Obstetrician/Gynaecologist with a Medical practice in the JOHNSON BUILDING in THE VALLEY.

Dr. Brett Hodge

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