Premenstrual syndrome or PMS is a group of symptoms that start one or two weeks before your period. Most women have at least some symptoms of PMS and the symptoms go away after their period starts. For some women, the symptoms are severe enough to interfere with their lives. They have a type of PMS called premenstrual dysphoric disorder or PMDD.
More common in a woman aged 30-45. It may be due to childbirth or a disturbing life event .there are no abnormal pelvic findings expecting features of pelvic congestion. Psychological and physiological factors may be involved to produce behavioural changes.
In the general population, 15% of the women are asymptomatic. 50% have mild PMS symptoms, 30% are moderate and the remaining 5-10% are severe.
1) Breast swelling and tenderness
3) Bloating and weight gain
4) Pain – headache or joint pain
5) Food cravings
6) Irritability, mood swing, crying spells, depression
Many things have been tried to ease the symptoms of PMS. No treatment works for every woman. You may need to try different ones to see what works for you. Some treatment options include –
1) Lifestyle change – we know that aerobic exercise increases blood flow to the brain and boosts mood-enhancing endorphins. Being active is also likely to have a positive effect on body image, feelings of being in control and generally having more energy and feeling healthier overall.
2) Medications –
Nonsteroidal anti-inflammatory drugs(NSAIDs) are painkillers that can also reduce inflammation (swelling).
Diuretics- Your doctors may prescribe a diuretic which is a medicine that helps you shed the extra water weight through natural means ( by peeing more often ).
Anti-depressants – There’s a connection between PMS and depression. Roughly half of women who go to their doctor for PMS also have it, as well as anxiety. If your doctor thinks that your depression needs to be treated, they may prescribe you an antidepressant.
3) Hormone therapies – Estrogen is clearly effective in relieving symptoms of PMS, whereas progesterone is ineffective and might even worsen symptoms. Combination oral contraceptives are effective, undoubtedly as a result of the estrogen component.
Oral contraceptive pills – to suppress hormones and to maintain a uniform hormonal milieu. the therapy is to be continued for 3-6 cycles Drospirenone containing OPCS are found to be better.
Progesterone is not effective in testing PMS. Levonorgestrel intrauterine system had been used to suppress the ovarian cycle.
Spironolactone – It is a potassium-sparing diuretic .it has anti-corticoid and anti-androgenic effects. It is given luteal phases(25-200 mg/day)
OOPHORORECTOMY – In established cases of primary PMS with recurrence of symptoms and approaching menopause, hysterectomy with bilateral oophorectomy is the last resort.
If your PMS isn’t that bad that you need to see a doctor, some lifestyle changes may help you feel better .
Steps you can take to help you ease symptoms –
1) Exercise regularly – Moderate aerobic exercise promoting cardiovascular work is highly recommended. Each week you should get at least two hours and 30 minutes of moderate-intensity physical activity.
2) EAT healthy foods – such as fruits, vegetables and whole grain. Avoid salt and sugary foods, caffeine and alcohol. especially when you are having PMS symptoms -.
vitamin B6 – possible benefits, Vitamin E – Promising, Calcium (1200-1600 mg) some improvement, Magnesium – most beneficial for premenstrual anxiety and lastly evening Primrose oil – it is of value for Nostalgia only.
3) Get enough sleep – Try to get 8 hours of sleep every night.
4) Yoga – Practising yoga, deep breathing and meditation can help you relax and reduce anxiety.
5) Cognitive behaviour therapy – (CBT) can also help ease stress. This type of therapy will help you to examine your feelings and thoughts, learn to interpret them in a more realistic way, and apply coping methods.
6) DON’T SMOKE – Research shows women who smoked were more likely to develop moderate or severe PMS compared with women who never smoked. Why this is the case is not clear, but quitting smoking will benefit your overall health significantly, not just your PMS symptoms.
7)Phytoestrogens- a possible benefit for PMS symptoms.
8) Herbal remedies – benefit of vitex Agnes castus(20mg od)
9) homoeopathy – improvement in 90%
Over the counter pain, relievers may help ease physical symptoms such as cramps headaches, backaches and breast tenderness. these include – ibuprofen ketoprofen , naproxen . aspirin.
Researchers continue to search for new ways to treat PMS. The exact causes is unknown but the following hypothesis is postulated by the American college of obstetricians and gynaecologists(ACOG)-
Alteration in the levels of estrogen and progesterone. Either there is altered estrogen or diminished progesterone level.
Neuroendocrine factors –
1) Serotonin- during PMS decreased synthesis of serotonin is observed.
2) Endorphins – Withdrawal of endorphins from CNS during luteal phase leads to symptom complex of PMS
3) Alpha- Aminobutric (GABA) – suppresses the anxiety levels in the brain.