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Definition of Premenstrual Syndrome (PMS)
A constellation of symptoms that occurs in a regular pattern aligned with a woman’s menstrual cycle. Doctors believe PMS results from the hormonal shift in the balance between estrogens and progesterone that follows involution of the corpus luteum. This shift sets in motion the events that produce menstruation.
PMS tends to begin during the last half of the luteal phase and continue to the onset of menstrual bleeding, typically spanning five to seven days.
As many as 85 percent of women experience some symptoms of PMS; about 10 percent experience symptoms significant enough to interfere with daily activities. Some doctors call debilitating symptoms premenstrual dysphoric disorder (PMDD).
Symptoms and Diagnostic Path
The symptoms of PMS may vary from month to month in a woman and also vary widely among women. Common PMS symptoms include
- Irritability, extreme emotions, and mood swings
- Mastalgia (painful breasts)
- Confusion, forgetfulness, and difficulty concentrating
- Abdominal cramping and bloating
- Low back ache or pain
- Fluid retention and swelling of the hands, ankles, and feet
- Weight gain (as much as two to four pounds)
The diagnostic path begins with a comprehensive medical examination, including pelvic examination. The doctor may ask the woman to keep a daily diary of her symptoms over three to six months, which helps to establish a clear pattern of symptoms and their severity.
The doctor may request blood tests and abdominal ultrasound to rule out hormonal imbalances, ovarian conditions, and other possible causes for symptoms.
Treatment Options and Outlook
Mild to moderate Premenstrual Syndrome often improves with lifestyle modifications, including sufficient sleep, nutritious eating habits, daily physical exercise, meditation or other relaxation methods, and reduced caffeine consumption (though some women find the diuretic and mild stimulant effects of caffeine helpful).
Biofeedback and acupuncture are also often effective. Supplementation with B vitamins, vitamin E, and calcium appear to reduce PMS symptoms, though it may take several months for the effect to become apparent. Evening primrose oil, SOY and other phytoestrogens, dong quai, and black cohosh are among the herbal remedies that may relieve PMS symptoms.
Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (nsaids) relieve headache and mastitis, and may reduce other symptoms because of their actions to suppress the release of prostaglandins (chemicals that increase the sensitivity of nerves to pain signals).
Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressant medications, are effective in relieving moderate to severe PMS symptoms and are the current standard of care for PMS as well as PMDD. Researchers believe SSRIs work so well because they influence the neurohormonal interactions that take place in the brain.
Though some women find their symptoms improve with oral contraceptives (birth control pills), recent research suggests progesterone (which appears in the synthetic form progestin in many oral contraceptive formulas) is a key factor in causing Premenstrual Syndrome.
Current clinical guidelines recommend oral contraceptives as treatment for PMS only when the woman also desires to take them as a means of preventing pregnancy.
Risk Factors and Preventive Measures
PMS occurs only in menstruating women. However, though Premenstrual Syndrome is very common not all menstruating women experience it. Some research suggests that women may metabolize progesterone differently, accounting for differences in its effects during the menstrual cycle.
Lifestyle measures, medications, or a combination of approaches can help mitigate symptoms for many women, though there are no methods for preventing PMS.
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