Premenstrual Syndrome

“Emotional and physical symptoms are common during the premenstrual phase of the menstrual cycle,” says an article in the New England Journal of Medicine (NEJM).

This is called premenstrual syndrome (PMS). The symptoms can be mild to moderate. About 75 per cent of all menstruating women have had some symptoms of premenstrual syndrome during their lives.

About three to eight per cent of all menstruating women have severe form of premenstrual syndrome. This is called premenstrual dysphoric disorder (PMDD).

PMDD includes severe physical, emotional, and quality-of-life problems. Severe symptoms, such as anger that is out of control, seriously disrupt daily life.

The article says that the PMS usually starts when women are in their early 20s. But usually they do not seek help until they are in their 30s – usually in a progressively worsening situation.

Sometimes PMS or PMDD may continue into menopause. This makes it difficult to distinguish symptoms of early years of menopause from PMS and PMDD.

PMS and PMDD are related to hormonal changes during the menstrual cycle. A single cause has not been found. Some scientists think PMDD may be caused by an imbalance of a chemical in the body called serotonin.

Often the symptoms start a few days before a menstrual period, but they may start as much as 2 weeks before a period. Physical symptoms are the same for PMS and PMDD. With PMDD, however, the emotional symptoms are much more serious. One may feel very depressed and hopeless.

Physical symptoms may include: bloated stomach, swollen feet or hands, tender, enlarged breasts, crampy pain in the lower abdomen, weight gain, headache, nausea, vomiting, diarrhea, constipation, appetite changes, joint or muscle pain, and acne.

Emotional symptoms may include: irritability, anger, depression, anxiety, tension, fatigue, lack of energy, difficulty concentrating, crying spells, feeling overwhelmed or out of control, and lack of or decrease in sex drive.

Many women who have PMS also experience difficulties in their relationships with families and friends. With PMDD, these difficulties are severe.

PMS or PMDD cannot be diagnosed from any one physical examination or laboratory test. You will be required to keep a daily log of your mood and physical symptoms for 2 months. For you to be diagnosed with PMDD, your monthly symptoms must significantly interfere with work, school, or relationships.

Diagnosis can be difficult and may take several months of careful observation.

Treatment for this problem is difficult. The NEJM article says that the efficacy of lifestyle interventions such as diet, exercise, and vitamin supplements (vitamin B6), calcium carbonate therapy as well as psychotherapy for PMDD remains unclear.

Outcome of drug therapy remains uncertain – although it is worth trying. There are three groups of medications: selective serotonin-reuptake inhibitors, alternative psychotropic agents, and hormonal interventions.

There are anecdotal reports that aerobic exercise, rest, stress reduction, and less salt, caffeine, and refined sugar in diet may help.

Counseling may help with emotional or relationship difficulties.

Anti-inflammatory drugs, such as ibuprofen and naproxen, can help most premenstrual cramping and headaches. A mild diuretic (water pill) for bloating and swelling may be helpful.

Unfortunately, not an easy problem to fix. Especially, for young mothers with young children, life becomes very difficult. She needs all the support she can get from friends and families – and from a sympathetic physician.

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