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Premenstrual Syndrome (PMS): Causes, Symptoms, Diagnosis And Treatment

| Reviewed By Arya Krishnan

Most women experience certain signs like breast tenderness, irritation, craving for sweets, moodiness, bloating, stomach pain or headache one to two weeks before their period [1]. And some of these symptoms can affect your daily life activities. By now, you may have probably understood that we are talking about premenstrual syndrome (PMS), a common condition that affects more than 90 per cent of women.

What Is Premenstrual Syndrome (PMS)?

Premenstrual syndrome is a combination of physical, emotional or behavioural changes that starts just days or weeks before menstruation begins. It happens every month during the luteal phase of the menstrual cycle.

About five to eight per cent of women of reproductive age have PMS and most of these women tend to suffer from premenstrual dysphoric disorder (PMDD) [2]. PMDD is a severe form of PMS that may interfere with work, social activities and relationships.


Causes Of Premenstrual Syndrome

The exact cause of premenstrual syndrome is unknown. However, some researchers believe the following factors to be causes of premenstrual syndrome.

Hormonal changes - A fluctuation in the oestrogen and progesterone hormones could cause irritability, mood swings and headache [2].

Chemical changes in the brain - Fluctuation in serotonin levels can trigger premenstrual symptoms. Serotonin is a chemical in your brain that plays a crucial role in mood, emotions and thoughts [2].

Sex hormones - Fluctuations in sex hormones triggers the symptoms of PMS.


Symptoms Of Premenstrual Syndrome

The symptoms are often mild, but it can become severe [3]. According to the American Family Physician, upto 85 per cent of menstruating women have one or more premenstrual symptoms.

Physical symptoms

• Breast tenderness and swelling
• Headache
• Back pain
• Stomach pain
• Bloating
• Water retention
• Weight gain
• Nausea
• Muscle and joint pain

Emotional symptoms

• Anger
• Irritability
• Depressed mood
• Anxiety
• Tension
• Crying
• Mood swings
• Lack of concentration
• Confusion
• Restlessness
• Forgetfulness
• Loneliness
• Decrease in self-esteem

Behavioural symptoms

• Fatigue
• Dizziness
• Insomnia
• Food cravings or overeating
• Changes in sexual interest


Risk Factors Of Premenstrual Syndrome

• A family history of PMS.

• A family history of depression.

• History of depression or mood disorders like bipolar disorder or postpartum depression [4].

• Domestic violence.

• Substance abuse.

• Physical and emotional trauma.

• High levels of stress.

When To See A Doctor

If you are unable to manage your PMS and it is affecting your health and daily activities, consult a doctor.


Diagnosis Of Premenstrual Syndrome

The diagnostic criteria for PMS are based on the following symptoms [5].

• The presence of at least five symptoms in the luteal phase and at least one of which must be a mood symptom, which includes anxiety or tension, depressed mood and persistent anger and irritability.

• Marked affective lability like feeling suddenly sad or tearful.

• Decreased interest in usual activities.

• Lethargy

• Difficulty in concentrating.

• Marked changes in appetite

• Hypersomnia or insomnia.

• Being overwhelmed or out of control


Treatment Of Premenstrual Syndrome

A change in lifestyle and medications can bring relief from PMS symptoms.


Serotonin reuptake inhibitors (SRIs) -They are considered effective in relieving PMS symptoms as compared to anti-depressants. It lowers mood symptoms and improves the quality of life and social activities. The SRIs that have been shown to be effective are fluoxetine, citalopram, escitalopram, paroxetine, sertraline and venlafaxine [6].

Nonsteroidal anti-inflammatory drugs (NSAIDS) - These medications are given to ease abdominal cramping and breast swelling and tenderness.

Vitamin supplements - Calcium, folic acid, vitamin B6 and magnesium can ease cramps and reduce mood swings [6].


Lifestyle Changes

• Drink plenty of water to reduce abdominal pain.
• Eat a well-balanced diet.
• Reduce the intake of sugar, salt, caffeine and alcohol.
• Sleep for at least eight hours at night.
• Engage in 30 minutes of exercise such as walking, cycling or swimming.
• Try doing deep-breathing exercises to relieve stress.

Common FAQs

1. Does PMS get worse with age?

A. Yes, the PMS symptoms may worsen as you reach your late 30s or 40s and attain menopause.

2. How long does PMS last?

A. Before menstruation starts, PMS symptoms can begin on the 14th day of the cycle and last until seven days after the menstruation starts.

3. What kind of health problems do PMS have an effect on?

A. PMS can affect depression and anxiety disorders, irritable bowel syndrome, chronic fatigue syndrome and bladder pain syndrome.

Arya KrishnanEmergency Medicine
Arya Krishnan
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