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Premenstrual syndrome (PMS)

Premenstrual Syndrome (PMS)

Humza Khizer

Overview

Premenstrual syndrome, or PMS, is the term used to describe a group of emotional and physical symptoms that affect women in the days before the start of their periods. 
&nbsp;

Premenstrual syndrome (PMS) is characterized by mild, recurrent symptoms that begin during the luteal phase of menstruation and end with menstruation. These symptoms include emotional disturbances, such as depression or mood swings, and physical changes such as <a href="https://merisehat.pk/disease/breast-pain">breast pain</a> or bloating. They typically go away once the period starts or soon after it starts. 
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Approximately 80% of women of reproductive age experience some symptoms in the premenstrual phase of the menstrual cycle<a href="#accordion">[1]</a>. The global pooled prevalence of PMS is approximately 47.8%, with 20% of women experiencing severe symptoms that disrupt their daily activities<a href="#accordion">[7]</a>. Female university students have the greatest number of cases with prevalence reaching as high as 91.8% in Turkey and 65% in Egypt<a href="#accordion">[7]</a>. Other countries, such as Japan (79%) and Taiwan (65%) have also reported a high prevalence of PMS among university students<a href="#accordion">[7]</a>. 
&nbsp;

While premenstrual syndrome does not have specific subtypes, there exists a severe form called premenstrual dysphoric disorder (PMDD). It affects about 2.5-3% of menstruating individuals<a href="#accordion">[7]</a>. Women from any socioeconomic, cultural, or racial background may be affected by this illness.

Typically a chronic illness, PMDD can significantly lower a woman&#39;s quality of life. Fortunately, most women may effectively control their symptoms with several therapies and self-care techniques. 
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Signs and Symptoms

While PMS frequently has mild to moderate symptoms that have little to no influence on day-to-day activities, symptoms can also be severe enough to harm daily activities and general well-being. Women may experience just one symptom or a wide variety of signs and symptoms. They typically vary from person to person and alter with age. 
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<h5>Emotional And Behavioral Symptoms</h5>

Mood, emotional, and behavioral changes brought on by PMS may include: 
&nbsp;

<ul>
	<li>Anxiety, restlessness, or a heightened sense of irritation.</li>
	<li>Appetite changes, including increased food cravings, particularly for sweets.</li>
	<li>Sleep pattern changes, such as weariness and difficulty sleeping.</li>
	<li>A sad or depressed mood (this may include tearfulness or uncontrollable crying).</li>
	<li>Rapid mood swings and emotional outbursts.</li>
	<li>Reduced sex drive.</li>
	<li>Having trouble concentrating or recalling information. 
	&nbsp;</li>
</ul>

<h5>Physical Symptoms</h5>

<ul>
	<li>Bloating</li>
	<li>Cramping</li>
	<li>Breasts that are sore and swollen</li>
	<li><a href="https://merisehat.pk/disease/acne">Acne</a></li>
	<li>Greasy hair</li>
	<li><a href="https://merisehat.pk/disease/constipation">Constipation</a></li>
	<li>Diarrhea</li>
	<li>Headaches</li>
	<li>Muscle and back discomfort</li>
	<li>Sensitivity to light or sound</li>
	<li>Clumsiness 
	&nbsp;</li>
</ul>

Other nonspecific symptoms include syncope, vertigo, palpitations, headache, and paresthesias. Moreover, certain pre existing disorders (skin disorders, migraines, seizures, eye problems, sleep disorders, respiratory disorders, etc) may worsen with PMS. 
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<h5>Symptoms Of Premenstrual Dysphoric Disorder&nbsp;(PMDD)</h5>

PMDD symptoms are similar to PMS symptoms. However, they are significantly more intense, especially regarding emotional responses and mood. Women are more likely to experience rage, extreme depression, and anxiety than with PMS.

PMDD symptoms, like PMS symptoms, can be caused by variations in estrogen, progesterone, and serotonin levels. 
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Symptoms might include:

<ul>
	<li><a href="https://merisehat.pk/disease/depression">Depression</a>, profound sadness, and tears</li>
	<li>Suicidal ideas</li>
	<li>Anxiety attacks</li>
	<li><a href="https://merisehat.pk/disease/anxiety">Anxiety</a>, rage, or irritation</li>
	<li>Sudden mood swings</li>
	<li>Insomnia</li>
	<li>Problems thinking or concentrating</li>
	<li>Bloating</li>
	<li>Painful cramping</li>
	<li>Bloating 
	&nbsp;</li>
</ul>

Causes

Scientific research has not found a definite cause of PMS, nor has it identified why some people suffer more severely than others. Nonetheless, scholars have proposed other possibilities. 
&nbsp;

<ul>
	<li>Cyclical Changes In Hormones</li>
</ul>

Many scientists believe PMS is caused by fluctuations in estrogen and progesterone levels. These hormones naturally change throughout the menstrual period. Hormones rise and then rapidly decrease during the luteal phase, which follows ovulation and can cause anxiety, irritability, and other mood changes. 
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<ul>
	<li>Chemical Changes In The Brain</li>
</ul>

Serotonin and norepinephrine are neurotransmitters that help control mood, emotions, and behavior. These chemical messengers may potentially play a role in PMS symptoms. A decrease in estrogen, for example, may cause the release of norepinephrine, resulting in decreased production of dopamine, acetylcholine, and serotonin. These alterations can cause sleep issues and a poor or depressed mood. 
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<ul>
	<li>Depression</li>
</ul>

Although depression alone is not responsible for PMS symptoms, some women with PMS have undiagnosed depression. 
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Note: If you notice any intense emotions, suicidal ideations, or persistent thoughts of death before or around the time of your periods, seek health immediately. 
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<h5>Causes Of Premenstrual Dysphoric Disorder&nbsp; (PMDD)</h5>

Studies indicate that fluctuating hormone levels, such as those of estrogen and progesterone, may also impact the brain&#39;s neurotransmitters, including serotonin, a compound that impacts mood.

It is unknown why some women experience premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) while others do not. Women with and without these illnesses have comparable levels of progesterone and estrogen. Based on several studies, it is most likely that PMDD is caused by women having heightened sensitivity to typical variations in hormone levels. 
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There are no screening tests for premenstrual syndrome. 
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Diagnosis

PMS and premenstrual dysphoric disorder cannot be diagnosed by a single test (PMDD). Physical as well as behavioral symptoms are required, and the symptoms must only manifest during the second half (luteal phase) of the menstrual cycle, often five to seven days before the menstrual period. These symptoms shouldn&#39;t be noticeable in women with PMS or PMDD between days 4 and 12 of a 28-day menstrual cycle. 
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<h5>Blood Tests</h5>

There is no need for blood tests to identify PMS or PMDD. A blood count may be advised to rule out other medical problems that cause exhaustion, such as anemia. Thyroid function tests can reveal hypothyroidism (an underactive thyroid gland) or hyperthyroidism (an overactive thyroid gland), both of which produce symptoms comparable to PMS and PMDD. 
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<h5>Recording Symptoms</h5>

Even though a woman&#39;s symptoms might point to PMDD, a doctor would ask that she meticulously record them every day for two complete menstrual cycles.

The doctor will inquire about the symptoms, when they experience them, and how they affect the person&rsquo;s daily life. It is normal to suffer one or two unpleasant symptoms occasionally before the period, but this isn&#39;t the same as PMS.

The doctor will determine whether the individual has PMS if they experience at least one symptom that starts within five days of their period and disappears within four days of it ending. A formal diagnosis can only be made once these symptoms have persisted for at least three menstrual cycles. 
&nbsp;

The Doctor Might Inquire About Questions Like:

<ul>
	<li>How many days elapse between each period?</li>
	<li>How long does bleeding last?</li>
	<li>How many light, medium, or heavy days are there?</li>
	<li>What signs are experienced?</li>
	<li>When did the symptoms start or end?</li>
	<li>When do the symptoms get better/worse?</li>
	<li>Can symptoms be predicted before they appear? How so?</li>
	<li>Do the symptoms affect daily life? How so? 
	&nbsp;</li>
</ul>

To rule out possible causes of symptoms other than PMS, the doctor may also inquire about the medical history and current medications. Since many illnesses (including mood disorders) run in families, they might also inquire about the family&#39;s medical history. Furthermore, the doctor may recommend a pelvic exam to rule out gynecological conditions. 
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Treatment

<h5>Conservative Treatments</h5>

First, conservative PMS therapy, including routine exercise, relaxation techniques, and vitamin and mineral supplementation, may be suggested. Some women find these treatments to be symptom-relieving, and they have minimal to no side effects. Prescription medicine is a possible alternative if these treatments are ineffective in providing enough relief.

Along with a prescription drug, conservative therapies are advised for women with premenstrual dysphoric disorder (PMDD). 
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<h5>Exercise</h5>

Exercise can assist in lowering stress, tension, anxiety, and depressive symptoms. 
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<h5>Relaxation&nbsp;Therapy</h5>

Stress, anxiety, despair, and other mental illnesses can exacerbate PMS and PMDD. Furthermore, having PMS or PMDD can make it difficult to maintain connections with others, perform well at work or school, and manage daily tasks. Meditation, progressive muscle relaxation, self-hypnosis, and biofeedback are a few examples of relaxation therapy techniques that can assist in reducing stress and anxiety from daily life. 
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<h5>Medications</h5>

<ul>
	<li>NSAIDs - Nonsteroidal anti-inflammatory medicines (NSAIDs) can help alleviate breast discomfort and menstrual cramps if used during the period or near the time the symptoms begin. Ibuprofen, naproxen sodium, acetaminophen, and aspirin are some common options. These are available over the counter. However, in case of severe symptoms, a larger dose may be prescribed by doctors.</li>
	<li>Hormonal Birth Control - Medicines that prevent ovulation might alleviate unpleasant physical symptoms such as soreness and discomfort. It may take trial and error to determine which type of birth control works best for the individual. Birth control pills, patches, and rings (NuvaRing) are all options.</li>
	<li>Antidepressants And Anti-anxiety Medications - The most commonly used antidepressants to treat mood-related difficulties associated with PMS are selective serotonin reuptake inhibitors (SSRIs). Fluoxetine, paroxetine, and sertraline are all options. These should be taken on a doctor&rsquo;s advice.</li>
	<li>Selective Serotonin Reuptake Inhibitors - The symptoms of PMS and PMDD can be effectively treated with selective serotonin reuptake inhibitors (SSRIs). The SSRIs include paroxetine, sertraline, citalopram, and fluoxetine. It is often the first-line treatment of severe PMS with majorly emotional symptoms.</li>
	<li>Diuretics - Symptoms like bloating and breast discomfort can be relieved by diuretics. 
	&nbsp;</li>
</ul>

<h5>Regular Exercise</h5>

Running, brisk walking, cycling, or swimming can all be used as moderate cardio exercises to relieve stress and improve mood. 
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<h5>Healthy Diet</h5>

Two weeks before menstruation, it is advised to cut back on salty, fatty, and sugary foods, as well as coffee and alcoholic beverages. Moreover, people should eat six small meals each day rather than three larger ones while on their period. Alternatively, they can also consume three small meals and three small snacks. A healthy diet and well-spaced meals can help improve the gut and mood. 
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<h5>Plenty Of Sleep</h5>

Sleeping for at least eight hours every night can lessen irritability. The additional benefit of synchronizing the internal clock by rising and retiring at the same time every day reduces the likelihood of experiencing mood swings during the day. 
&nbsp;

<h5>Yoga</h5>

Exercises like yoga, meditation, and breathing techniques reduce stress and stave off the anger and melancholy that frequently accompany PMS. 
&nbsp;

<h5>Vitamins, Minerals, And Supplements</h5>

It is advisable to speak with a healthcare professional before taking vitamins, minerals, and herbal supplements because they aren&#39;t subject to the same FDA regulations as over-the-counter and prescription medications. Nevertheless, there is some proof that they can alleviate PMS.<a href="#accordion">[2]</a> 
&nbsp;

<ul>
	<li>Calcium - According to research, calcium may help with symptoms including exhaustion, desires for food, and even sadness. This reduction was confirmed by a retrospective evaluation of all symptoms. Throughout the calcium treatment period, 73% of the female participants reported reduced symptoms<a href="#accordion">[3]</a>. Dairy products (milk, eggs, yogurt), meals with calcium added (certain cereals and bread), and supplements are all good sources of calcium.&nbsp;</li>
	<li>Magnesium - There is conflicting research about the benefits of magnesium for PMS symptoms such as headaches, stress, and anxiety<a href="#accordion">[4]</a>. Magnesium can be found in leafy greens, almonds, whole grains, and supplements.</li>
	<li>Vitamin B6 - According to some research, vitamin B6 helps lessen mild to moderate PMS symptoms. Fish, chicken, potatoes, non-citrus fruits, and supplements are all good sources of vitamin B6.&nbsp;</li>
	<li>Omega-3 and Omega-6 - Omega-3 and Omega-6 fatty acids have been found in several trials to reduce PMS symptoms. Omega-3 and Omega-6 fatty acids can be obtained through fish, flaxseed, almonds, leafy greens, and supplements.</li>
	<li>Herbal Supplements&nbsp;- With varying degrees of efficacy, various herbal remedies are used to treat PMS symptoms. These include dried chaste berries, black cohosh, and evening primrose oil. Vitex agnus-castus is the only type of herbal medicine proven to improve PMS-associated emotional symptoms.<a href="#accordion">[5]</a> 
	&nbsp;</li>
</ul>

Note: Consult a healthcare professional before starting any medication, vitamins, minerals, or herbal supplements. 
&nbsp;

While premenstrual syndrome typically resolves once the periods begin, its severe form, PMDD can lead to sadness and, in extreme situations, suicide. The disease can lead to serious emotional distress as well as a negative impact on relationships, sexual life, and jobs.

&nbsp;

Women can experience the symptoms of PMS with or without the presence of risk factors. However, the following factors can increase the risk of PMS or more severe PMS symptoms: 
&nbsp;

<ul>
	<li>White women experience PMS more frequently.</li>
	<li>Family history of PMS or mental health issues, such as postpartum depression and depression.&nbsp;</li>
	<li>Obese or overweight Sedentary lifestyle.</li>
	<li>Sleep disturbances.</li>
	<li>A diet high in sugar, salt, or red meat.&nbsp;</li>
	<li>Smoking and alcohol.</li>
	<li>Stress.&nbsp;</li>
	<li>History of physical, sexual, or psychological trauma. 
	&nbsp;</li>
</ul>

While PMS cannot be prevented, it can be managed through dietary changes, medication, and/or the treatment of any existing depression or anxiety. These measures may also reduce the likelihood that PMS will progress to PMDD. However, PMDD may be a result of the way the individual&rsquo;s hormones function and may not be something they can control. In that instance, treatment may provide comfort. It is best to consult a healthcare professional regarding any concerns and advice. 
&nbsp;

A recent study was carried out to examine the impact of auriculotherapy on the severity of physical and mental PMS symptoms<a href="#accordion">[6]</a>.

Ninety-one females were randomly divided into three groups: auriculotherapy (AG), placebo (PG), and control group(CG). The women were administered the specific intervention once a week for 8 weeks. For women in the AG group microneedles were placed in seven PMS-related locations.

As per the overall results, the intensity of PMS symptoms decreased in the auriculotherapy and placebo groups. Anxiety and musculoskeletal discomfort, particularly in the head, breast, and lower back, both showed improved scores following the session in the auriculotherapy and placebo groups. These data indicate that auriculotherapy may be used in conjunction with other PMS therapies. 
&nbsp;

Key Points

<ul>
	<li>Premenstrual syndrome (PMS) is characterized by mild, recurrent symptoms that begin during the luteal phase of menstruation and end with menstruation.</li>
	<li>Symptoms of PMS&nbsp; include emotional disturbances, such as depression or mood swings, and physical changes such as breast pain or bloating. They typically go away once the period starts or soon after it starts.</li>
	<li>While premenstrual syndrome does not have specific subtypes, there exists a severe form called premenstrual dysphoric disorder (PMDD). It affects about 2.5-3% of menstruating individuals.</li>
	<li>PMDD is characterized by anxiety attacks, irritability, anger, suicidal ideas, and severe mood swings.</li>
	<li>Many scientists believe PMS is caused by fluctuations in estrogen and progesterone levels.</li>
	<li>PMS symptoms can be treated with medications (birth control pills, antidepressants), vitamins and supplements, exercise, a healthy diet, yoga, meditation, etc. 
	&nbsp;</li>
</ul>

[1] Raval CM, Panchal BN, Tiwari DS, Vala AU, Bhatt RB. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder among college students of Bhavnagar, Gujarat. Indian J Psychiatry. 2016;58(2):164.

[2] Bendich A. The potential for dietary supplements to reduce premenstrual syndrome (PMS) symptoms. J Am Coll Nutr. 2000;19(1):3–12.

[3] Thys-Jacobs S, Ceccarelli S, Bierman A, Weisman H, Cohen M-A, Alvir J. Calcium supplementation in premenstrual syndrome. J Gen Intern Med. 1989;4(3):183–9.

[4] Shamberger RJ. Calcium, magnesium, and other elements in the red blood cells and hair of normals and patients with premenstrual syndrome. Biol Trace Elem Res. 2003;94(2):123–9.

[5] Panay N. Management of premenstrual syndrome. J Fam Plan Reprod Heal Care. 2009;35(3):187.

[6] Korelo RIG, Moreira NB, de Carvalho Miguel BA, da Cruz C de G, de Souza NSP, de Macedo RMB, et al. Effects of Auriculotherapy on treatment of women with premenstrual syndrome symptoms: A randomized, placebo-controlled clinical trial. Complement Ther Med. 2022;66:102816.

[7] Gudipally PR, Sharma GK. Premenstrual Syndrome. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.