Definition

Premenstrual syndrome (PMS) is a collection of symptoms experienced by women before their menstrual period begins. Approximately 90% of women of reproductive age have experienced PMS symptoms.

Research estimates that around 14 to 88 percent of adolescent girls experience moderate to severe symptoms. Symptoms usually appear 1-2 weeks before the first day of menstruation and can include physical, behavioral, or emotional symptoms.

About 3-8% of women of reproductive age are estimated to experience premenstrual dysphoric disorder (PMDD), a severe form of PMS that can interfere with daily life. Women with this condition may experience mood swings, anxiety, difficulty concentrating, sleep disturbances, and others.

Causes

The exact cause of PMS is not well understood. However, researchers suggest that this condition is related to changes in sex hormones and serotonin levels when the menstrual cycle begins. An increase in sex hormones such as estrogen and progesterone can trigger physical complaints, mood changes, anxiety, and other emotional issues.

PMS triggered by hormonal changes typically disappears in women who become pregnant or have reached menopause.

In addition, changes in brain chemicals like serotonin can also affect mood. Reduced serotonin levels before menstruation can cause emotional changes. Women with depression, where serotonin levels are low, may be at increased risk of experiencing PMS.

Risk Factor

PMS can be experienced by any woman. However, there are several risk factors that may increase the risk of PMS, including:

• A history of depression can increase the risk of PMS, particularly severe PMS
• A family history of PMS
• A history of physical or emotional trauma
• Smoking or alcohol consumption habits
• Excessive consumption of salty or sugary foods
• Lack of exercise or physical activity
• Obesity, or a body mass index (BMI) of ≥30
• Lack of rest

Symptoms

The average menstrual cycle is 28 days. PMS symptoms can start after ovulation and last until about 5 days after menstruation begins. Symptoms vary from woman to woman and can range from mild to moderate. Generally, symptoms do not significantly affect daily activities.

PMS is characterized by both physical and emotional symptoms. You may experience the following symptoms:

1. Physical symptoms:

• Bloating
• Abdominal pain or cramps
• Swollen or tender breasts
• Headaches
• Joint or muscle pain
• Swelling in the hands or feet
• Acne or other skin issues
• Weight gain

2. Emotional symptoms:

• Irritability
• Anxiety
• Forgetfulness
• Fatigue
• Poor concentration
• Depression
• Insomnia
• Increased appetite

In some rare cases, symptoms may be severe enough to disrupt social interactions.

Diagnosis

Medical History

The diagnosis of PMS typically does not require special tests. A woman may be diagnosed with PMS if she experiences at least one physical and one emotional symptom. Symptoms occur approximately 5 days before menstruation begins for at least 3 consecutive menstrual cycles.

Thus, doctors usually need to review the history of the menstrual cycle to identify symptoms over at least 2 recent menstrual cycles. Patients are also advised to keep a personal menstrual note to help in diagnosis.

Physical and Supportive Examinations

Next, the doctor will perform a physical examination, especially on the body parts where symptoms occur. In certain cases where the doctor suspects other specific causes of the symptoms, supportive tests may be conducted. An example is a thyroid function test to rule out thyroid gland disorders as the cause.

Premenstrual Dysphoric Disorder (PMDD) is a more severe form of PMS. PMDD can be diagnosed using the following criteria:

1. The presence of at least 5 physical and emotional symptoms within a week before menstruation begins.
2. Symptoms accompanied by social impairment, such as disruption in work, school, relationships, or daily activities.
3. Symptoms that are not related to or do not originate from another illness, such as depression or personality disorders.
4. Symptoms must occur in at least 2 menstrual cycles.
5. Symptoms are not related to the effects of any particular substance, such as drug abuse or medication side effects.

Management

The goal of PMS treatment is to relieve symptoms. The main approach to managing symptoms involves lifestyle modifications such as:

• Engaging in regular physical activity or exercise
• Eating a balanced diet
• Getting sufficient and quality sleep, about 7-9 hours per day
• Quitting smoking or drinking alcohol
• Managing stress through counseling or relaxation
• Reducing caffeine intake or following a caffeine-free diet

Medications may be prescribed based on the symptoms experienced. Some treatments for PMS include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or paracetamol, which are particularly useful for relieving physical symptoms like abdominal pain, breast tenderness, or other body aches
• Vitamins such as B vitamins, vitamin D, calcium, magnesium, and folic acid may help alleviate symptoms
• Birth control pills to stop ovulation, thereby reducing physical PMS symptoms
• Antidepressants can relieve emotional symptoms, but they must be prescribed by a doctor
• Diuretics may help reduce swelling caused by fluid retention, but they are also prescribed by a doctor

If symptoms do not improve or worsen despite medication, further treatment options, including hormonal therapy, may be recommended.

Complications

PMS can lead to several complications, such as:

• Premenstrual Dysphoric Disorder (PMDD)
• Disruption of daily activities or social interactions
• Eating disorders, such as bulimia
• High blood pressure or hypertension

Prevention

Currently, there is no specific prevention for PMS because the exact cause is still unknown. However, adopting a healthier lifestyle can help reduce the risk of PMS.

When to See a Doctor?

PMS symptoms typically subside once menstruation begins. However, if symptoms become very disruptive, persist, and do not improve with over-the-counter medications, you should see a doctor.

Looking for more information about other diseases? Click here!