What is Premenstrual Syndrome (PMS)?
Premenstrual syndrome (PMS) encompasses symptoms felt by women in the weeks leading up to menstruation in their monthly cycle.
Up to forty percent of women of reproductive age suffer from premenstrual syndrome (PMS) which interferes with daily life in some way. Most women will experience some symptoms of this condition at some point in their lives.(1, 2)
This condition usually manifests in the two weeks before menstruation begins. The symptoms improve once bleeding (menses) starts. (3)
Symptoms
Symptoms associated with premenstrual syndrome (PMS) can vary from mild to severe. They can also interfere with a woman’s quality of life.
The exact cause of this condition is not fully understood. It might be linked to changes in levels of hormones or chemicals in the body which change throughout the menstrual cycle.
Hormone changes can affect women in different ways and some may be more susceptible than others. Often women who use hormonal contraception are less affected by these changes.
PMS has also been linked to some chemical substances which are present in the blood (neurotransmitters) such as gamma-aminobutyric acid (GABA) serotonin. (4)
The symptoms associated with this condition can be emotional or physical.
Emotional Symptoms
Symptoms affecting moods and behavior often manifest from the time of ovulation through to menses. These include:
Tension and Anxiety
Some might feel levels of stress or tension which interfere with their ability to think clearly and rationally. They might also feel nervous, apprehensive and worried. (5)
Depression
Depression makes people feel down and sad, and negatively affects the way a person thinks and acts. (6)
Crying
Women might be very emotional and cry at the slightest thing which upsets them, or for no clear reason at all. (7)
Mood Swings
Changes in mood might be frequent and vary from irritability through to anger and being bad tempered. These changes can be unpredictable with no apparent trigger. (8)
Social Withdrawal
Everyone enjoys some quiet time alone now and again. However, women with premenstrual syndrome (PMS) might find themselves withdrawing from social situations. They might not feel like leaving the house or spending time with friends. (9)
Poor Concentration
Concentration levels might drop and activities that involve detail might be avoided. It might be hard to sit and complete a crossword or read a book. Women might find it harder to complete everyday tasks like driving or shopping. (10)
Insomnia
Someone suffering from insomnia has difficulty falling asleep or staying asleep. This results in a feeling of not being rested during the day. This is a symptom associated with premenstrual syndrome (PMS). (11)
Appetite Changes and Food Cravings
Changes in appetite can be present, either eating more or less than usual. Craving particular foods such as chocolate are common in PMS (12)
Libido
A woman’s sex drive can also be affected when suffering from premenstrual syndrome. For some it can increase, but usually a disinterest in sex manifests. (13)
Physical Symptoms
Premenstrual syndrome (PMS) affects the body in several ways. Physical symptoms of this condition include:
Pain
Premenstrual syndrome can lead to back pain, abdominal pain, muscular pain, and joint pain. Some women also experience headaches. (14)
Breast Tenderness
Breasts might feel tender and swollen, particularly just before a woman’s period starts. (15)
Bloating
Abdominal bloating and water retention can be experienced when premenstrual. Swelling in the hands and feet might also be present. Some women also put on weight. (16)
Fatigue
Fatigue, a feeling of extreme tiredness and lethargy, is not uncommon. This results in a lack of energy to carry out every day tasks. (17)
Gastrointestinal Issues
Premenstrual syndrome (PMS) can cause issues with digestion. It can also result in diarrhea or constipation. (18)
Skin Issues
A flare up of acne or just the odd breakout of spots can happen. Some women might also find their hair gets greasier more quickly when premenstrual. (19)
Premenstrual Dysphoric Disorder (PMDD)
Some women’s symptoms are very severe, affecting their ability to function. This could be between three and eight percent of women with premenstrual syndrome (PMS).
Usually associated more with emotional symptoms, this is classed as premenstrual dysphoric disorder. (20)
Stages
There are no stages for this condition. There are however criteria which medical professionals use for diagnosis.
Prior to diagnosis for premenstrual syndrome (PMS) other conditions will be excluded.
These include mental disorders like depression, anxiety, personality disorders and dysthymia. Other conditions include the eating disorders anorexia and bulimia. There are also medical conditions including diabetes, anemia, endometriosis and hypothyroidism which may be ruled out.
Further considerations will be substance or alcohol abuse, use of the contraceptive pill and being perimenopausal.
All these disorders, conditions and illnesses can present with similar symptoms to premenstrual syndrome (PMS).
There are two sets of criteria followed for diagnosis of this condition. The first from the National Institute of Mental Health, the second from the University of California in San Diego.
Guidelines from National Institute of Mental Health
There will be an increase of the symptoms associated with premenstrual syndrome (PMS) of 30 percent between days and five and ten of a woman’s menstrual cycle. These are compared to the symptoms for the six days before menses begins.
In addition these symptoms and changes must be documented in a daily diary. This should be kept for at least two consecutive menstrual cycles.
Guidelines from University of California
These guidelines divide the symptoms into affective and somatic groups. At least one symptom from each group must be present in the five days preceding menses for three consecutive cycles. These consecutive menstrual cycles must be the three prior to diagnosis
Affective symptoms include irritability, anxiety, depression, angry outbursts, social withdrawal and confusion.
Somatic symptoms include bloating, headaches, breast tenderness and swelling in the hands and feet.
Symptoms will improve between days four to thirteen of the monthly cycle. (21)
Treatment
The first line of treatment for premenstrual syndrome (PMS) is making lifestyle changes.
Self Help Treatment
Practicing regular exercise and following a healthy balanced diet helps relieve the symptoms of premenstrual syndrome (PMS). Another beneficial change is getting plenty of sleep. The recommendation is seven to eight hours a night.
Keeping stress levels under control by meditating or doing yoga can also help.
Painful symptoms can be relieved by using over the counter painkillers. These include ibuprofen and paracetamol.
Smoking and consumption of alcohol should be avoided.
A daily diary recording the symptoms experienced should be kept for about two to three menstrual cycles. This can then be taken to a doctor to help diagnosis and treatment.
If self help methods are not working, see a doctor. Medical advice should also be sought if the symptoms are severe and affecting quality of life and day to day function. (22)
Medical Treatment
Besides making lifestyle changes, there are treatments which a doctor can recommend.
There are medications such as hormonal contraceptives which can prevent ovulation. These might help relieve the physical symptoms associated with premenstrual syndrome (PMS). However, they might not be as effective in lessening the emotional symptoms.
It might be necessary for several of these medications to be tried to find one which works.
Antidepressant medications might relieve some of the emotional symptoms associated with this condition. Anti-anxiety medicines can also be used if other medications do not work. These type of medications are usually only taken when emotional symptoms are present.
Diuretics or water tablets can help reduce symptoms associated with water retention. (23)
Cognitive behaviour therapy might help women who suffer psychological issues as a result of premenstrual syndrome. (24)
FAQ
What is premenstrual syndrome (PMS)? Premenstrual syndrome (PMS) encompasses symptoms felt by women in the weeks leading up to menstruation in their monthly cycle.
What are the signs of premenstrual syndrome (PMS)? Signs of this condition can be emotional or physical. Emotional and behavioral symptoms include: depression, mood swings, crying, anxiety, and lack of concentration. They may also encompass loss or gain in appetite, food cravings and changes in libido. Physical symptoms include pain, bloating, gastrointestinal issues, skin issues and breast tenderness.
How do you develop premenstrual syndrome (PMS)? The exact cause of this condition is at present unknown. Hormonal and chemical changes in the body are thought to play a part.
How are you diagnosed for premenstrual syndrome (PMS)? Doctor diagnose this condition based on the amount, severity and frequency of symptoms.
What is the best treatment for premenstrual syndrome (PMS)? Treatments include lifestyle changes, medications and therapy. A doctor will decide the best course of action for an individual.
What are the long term complications of premenstrual syndrome (PMS)? When severe the symptoms of this condition can lead to premenstrual dysphoric disorder (PDD).
Is premenstrual syndrome (PMS) considered a disability? This condition is not considered a disability.
Is there a cure for premenstrual syndrome (PMS)? There are treatments available which can successfully manage this condition.
Is premenstrual syndrome (PMS) life threatening? This is not considered to be a life threatening condition.
Summary
Premenstrual syndrome (PMS) encompasses symptoms felt by women in the weeks leading up to menstruation in their monthly cycle.
The emotional and physical symptoms, when severe, can interfere with daily life. Fortunately there are treatments available which allow women to manage this condition
successfully.