Premenstrual syndrome is
characterized by physical, emotional and behavioral
changes that occur a few days before menses or during the
menstrual period. The symptoms usually disappear with menses
or shortly thereafter.
Incidence of PMS
As many as 75% of women
have one or the other complaint before and during
menstruation. Around 50% of women suffer from PMS
severe enough to interfere with their daily
activities.
What causes PMS?
The exact cause is still not known but it is believed
that it happens due to the retention of water and salt
in the body, possibly due to increased estrogen (one
of the female hormones) production or due to some
disturbance in functioning of the adrenal cortex).
Who is at risk?
PMS is usually common in females:
in late 20s and early
40s.
taking oral
contraceptives
with a past history of
post-partum depression (depression following delivery)
or affective mood disorder
with a family history
of major depression
What are the
symptoms?
The pre-menstrual symptoms begin 7-10 days before
the onset of menses and subside with menses or
shortly thereafter. A wide range of physical,
emotional and behavioral changes may occur during PMS.
These include:
Physical symptoms
Dysmenorrhea:
Dysmenorrhea basically means painful menses.
The pain usually starts a few days before menses or
may accompany it, and usually subsides as bleeding
tapers off. It is characterized by sharp,
intermittent pain or dull, aching pain in the
pelvis or lower abdomen and the thighs. In fact,
it may be severe enough to interfere in performance of
daily activities and cause absence from work for 1 or
more days.
Headache: Some
females may complaint of migraine like pain before the
periods
Swelling of feet,
hands and sometimes face due to retention of water
and salt in the body. Swelling in the body may result
in a weight gain of as much as 1-1.5 kgs or
even up to 5 kgs.
Pain and a
feeling of fullness in breast
Feeling of fullness in
the abdomen.
Bowel changes
(constipation or diarrhea).
Backache or muscle
pain.
Frequency of
urination.
Feeling of body
discomfort.
Acne (pimples).
Unusual food cravings
especially for sugar and sweets
Emotional and
Behavioral symptoms
Irritability
Mood swings
Feeling of anxiety
Sadness and low
self-esteem
Aggressive behavior
Crying episodes
Changes in libido
Confusion
Oversensitive to
sensory stimulus (such as light, noise)
When to consult the
doctor
Mild symptoms are usually normal but if the PMS is
very severe and interferes with the normal activities
one needs to take medical help. Immediately consult
your doctor if:
symptoms persist and
do not subside even after treatment
symptoms are severe
enough to cause functional disability
there is marked
swelling in the body
symptoms are
interfering with your personal relationships
What are the
investigations to be done?
There are no specific tests to be done for PMS. The
doctor will ask you about the PMS symptoms, your
lifestyle and medical history. In some patients a
psychiatric evaluation may be done to rule out other
potential causes for symptoms that may be attributed
to PMS. After taking a complete history and performing
physical examination (including pelvic examination)
the doctor may advise some investigations to rule out
other causes of dysmenorrhea. These include:
Dilatation and
Curettage: It is a minor procedure which is done
to obtain endometrial tissue (inner lining of the
uterus)
Ultrasound and
X-ray
Management of PMS
Management of Premenstrual syndrome include:
General measures:
Certain lifestyle changes can help in preventing
or worsening of pre-menstrual symptoms. These include:
Maintain a calendar
of 3-4 menstrual cycles for the symptoms you
experience. This will help you to understand the
pattern of symptoms so that they can be prevented and
managed accordingly.
Taking a balanced
diet (rich in whole grains, vegetables and fruit).
Diet taken should be rich in vitamins (B, C, D, E),
minerals (such as calcium, iron, magnesium, zinc and
vitamins).
Taking diet rich in
fibers if one develops constipation during PMS.
Take calcium rich
diet as it helps in relieving the muscle pain and
discomfort. Milk and milk-based products are
rich sources of calcium. Calcium supplements
can also be taken as advised by the doctor.
Take zinc
supplements as low levels of zinc can cause
infected pimples and contribute to emotional symptoms
of PMS such as irritability, sadness, and nervousness.
Take less salt or
salt free diet for 10 days before the onset of
menses.
Sugar cravings
play a major role in PMS and eating complex
carbohydrates like rice and bread diminish the
craving and keep the blood glucose levels in check.
Alcohol may
greatly increase blood glucose levels which may be
harmful especially in Diabetes.
Caffeine (present
in tea and coffee) may decrease fluid retention
and tend to relieve the physical symptoms. However,
irritability, anxiety and mood swings may get
exaggerated in PMS. Therefore, coffee and tea intake
should be restricted.
Exercise tends
to increase the release of “feel good” hormones
known as endorphins but the duration for the same
should be at least 30 minutes.
Practice yoga
and stress relaxation techniques regularly.
Give adequate support
to the breasts to relieve the discomfort.
Treatment: The
main objective of treatment is to relieve both
physical and psychological problems in PMS.
Saline
purgatives or powerful diuretics such as
chlorthiazide are used to eliminate the excess water
in the body and serve to relieve pain and swelling.
Herbal
medications with anxiolytic (relieves anxiety),
spasmolytic (relieves spasm) and nausea
and/or vomiting relieving properties affords
considerable relief in PMS with minimal side effects.
Calcium
supplements to relieve menstrual cramps.
In some
cases tranquilizers, lithium, antidepressants and
hormonal supplements may also be prescribed but these
may have serious side effects.
