Premenopausal Syndrome PMS

What is premenstrual syndrome and how long is PMS supposed to last?

Premenstrual Syndrome (PMS, premenstrual tension) is a gynecological condition that occurs a week to 10 days before a woman’s period and usually resolves in a day or two of bleeding. Common symptoms of PMS include pain, irritability (73.33%), emotional instability, emotional liability, tearfulness (crying), nervousness, anxiety (58.3%), bloating, malaise, headache, stomach ache, lower back pain, acne, swelling (65%), mastalgia (tender breasts), depression, poor concentration, sensitivity to noise, mood swings, insomnia (sleeping problems), weight gain, increased hunger and cravings for certain foods (sugar cravings).

What are the risk factors for PMS?

Factors that can cause PMS include age, menstrual cycle patterns, socioeconomic status, use of hormonal contraceptives, and genetic predisposition (ethnicity). Other possible contributing factors include lifestyle habits, such as diet, sexual habits, and physical activities.

What is the worldwide prevalence of PMS?

PMS affects women of all backgrounds, regardless of race, or ethnicity, although Asian women, Brazilian women, American women, and Arabic women report the condition more often than European women.

About 90% of women experience PMS at some point in their lifetime

In 2016, The prevalence of PMS in women of reproductive age and among adolescent girls was 98% in Asian women, 97.2% in Brazilian women of African origin, 43.3% in Brazilian women of Arab descent, 41% in American women, 37.5% in Arabian women, 25.2% in Brazilian women of European descent, 17.5% in Japanese women, and about 10%–12%, in Europe.

Types

What are the types of premenstrual syndrome?

PMS is categorized into four main types based on symptoms. The four types of PMS are: PMS A, PMS C, PMS D, and PMS H.

PMS A is a common type of PMS characterized by anxiety, irritability, and nervous tension (mental pressure).

PMS C is a type of PMS characterized by headaches, increased appetite (polyphagia or hyperphagia), excessive desire for sweets (sugar cravings), fatigue, heart palpitations, and tremors (shakiness).

PMS D is a type of PMS in which depression is prevalent. Other characteristics of PMS-D include insomnia (sleeping problems), tearfulness, forgetfulness, and confusion (delirium).

PMS H is a type of PMS most commonly related with edema, it is characterized by swelling, water retention, mastalgia (breast tenderness), abdominal bloating, and weight gain.

Symptoms

What are the symptoms of premenstrual syndrome?

PMS can negatively affect the quality of life and mental health of the affected women; However, the severity of symptoms can vary significantly from woman to woman. Common symptoms of PMS include:

• Pain

PMS is characterized by lower abdominal pain (pelvic pain), distention, backache, severe aching joints, weak and sore legs (leg pains), cramp-like pain usually starts 7 to 10 days before a woman’s period and usually disappears with the onset of the menstrual bleeding.

• Weakness

PMS can cause restlessness, tremors and weakness. Weakness is often described as weak and shaky legs, and numbness in hands. You may feel weak, and your limbs may feel heavy. It may also feel like a tiredness and heaviness in legs

• General symptoms

PMS is a group of symptoms linked to your menstrual cycle. Common symptoms include nervousness, irritability, emotional liability, depression, headache, poor concentration, sensitivity to noise, and edema, especially in the following areas: facial, epigastric, mammary, umbilical, pubic, and in both upper and lower limbs

92% of women develop edema during the premenstrual period, especially in the second phase of the cycle

Causes

What are the causes of premenstrual syndrome?

Hormone changes, Fluctuations in estrogen and progesterone levels (sex hormones), might cause, or be correlated with, various premenstrual symptoms, such as anxiety, transient fluid retention and edema. Most girls and women with PMS have decreased allopregnanolone levels in cerebrospinal fluid.

Allopregnanolone is a progesterone-derived neurosteroid metabolite that inhibits anxiety (an anxiolytic, antipanic, or antianxiety agent).

What causes PMS mood swings?

Fluctuations in serotonin levels, might cause, or be correlated with, the mood symptoms of PMS. Serotonin is a neurotransmitter that plays a crucial role in the occurrence of mood swings or adverse mood changes.

Serotonin insufficiency or deficiency may contribute to the symptoms of PMS, such as depression, fatigue, insomnia (sleep problems), increased hunger and cravings for certain foods (sugar cravings).

Symptoms of PMS may get worse with stress or age

Lifestyle factors, Poor diet contributes to the development of PMS, as a poor diet can lead to poor neurotransmitter synthesis (serotonin and acetylcholine).

Serotonin synthesis depends mainly on the brain concentrations of L-tryptophan and tyrosine. The two nutrients, tryptophan and tyrosine, when simply ingested in food, can act like supplements contributing to important changes in the chemical composition and structure of myelin in the brain. However, when the concentration of neutral amino acids in the plasma is reduced, the diet-induced plasma changes induce parallel changes in the amounts of tryptophan or tyrosine that are transported from blood to brain across the blood-brain barrier (BBB). Moreover, the conversion of tryptophan into serotonin is influenced by the amount of dietary carbohydrate, the synthesis of serotonin in turn affects the type and amount of carbs you choose to eat.

Treatment

Classical treatment

How to treat PMS symptoms?

Dietary management, Reducing sodium intake, reduce sodium intake to less than 5 gr a day to reduce water retention.

Diuretics, using a diuretic, such as hydrochlorothiazide 25 to 50 mg per day orally, to increase urination and to reduce water retention

Oral contraceptives can be used to balance hormone levels and to help relieve premenstrual dysphoric disorder (PMDD)

Corticosteroids: using a long acting progestin, such as medroxyprogesterone acetate 200mg IM every 2-3 months, or by using 200-400mg vaginal progesterone suppositories per day to control inflammation.

What is the best medicine for PMS cramps?

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin, Advil), or diclofenac (Cambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex) are commonly used alone to relieve menstrual cramps and menstrual pain symptoms. Alternatively, Gonadotropin-releasing hormone agonists, such as Lupron Depot (leuprolide) 3.75 mg IM monthly for up to 6 months are often used to reduce PMS pain and to relieve severe menstrual cramps (dysmenorrhea) in patients with endometriosis or secondary dysmenorrhea.

How to reduce the risk of having severe premenstrual symptoms?

Supplements: taking vitamin B6  supplements (pyridoxine) by mouth, along with magnesium can reduce your risk of having severe premenstrual symptoms

What is good for PMS mood swings?

Calcium supplements are a first line choice if you suffer from premenstrual dysphoric disorder (PMDD), taking 800-1,200 mg of calcium a day reduced symptoms of moderate to severe premenstrual symptoms. Women who took calcium supplements for PMS experienced enormous relief from mood symptoms, pain, and bloating

What is the best medicine for PMDD?

Fluoxetine (Prozac, Sarafem) 20 mg per day orally or sertraline (zoloft®) 50 mg orally once a day are the most effective and widely used medicines for PMS to treat depression, panic attacks, anxiety and premenstrual dysphoric disorder (PMDD).

• Alternative treatment

How to relieve PMS naturally?

1. Choose a healthy, balanced diet and aim for a healthy weight, avoid caffeine, alcohol and nicotine
2. Vitamin and calcium supplements
3. Lifestyle changes, stop smoking, be physically active, reduce stress, go to gym at least twice weekly, engage in group sports, yoga, morning jogging, swimming, have a healthy sex life, pregnancy, etc.

Next steps management

How is Premenstrual Syndrome diagnosed?

Clinical examination to evaluate the patient

Routine blood tests to check for hormone levels, and measuring your neurotransmitters with a urine test (checking urinary neurotransmitter levels)

Transvaginal ultrasound or pelvic ultrasound to examine female reproductive organs to rule out endometriosis and to detect uterine cavity abnormalities, such as polyps, uterine fibroids, etc.

Menstrual Calculator (PMS Calculator), calculate your periods and include PMS days on your period calendar

 

 

 

 

References

 

 

 

Verified by: Dr.Diab (November 24, 2017)

Citation: Dr.Diab. (November 24, 2017). What is premenstrual syndrome PMS? Causes Symptoms and Treatment. Medcoi Journal of Medicine, 11(2). urn:medcoi:article15567.