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Premenstrual Syndrome

PMS

Premenstrual syndrome describes a group of symptoms, including breast tenderness, headache, abdominal cramps, fatigue, mood swings, irritability and dysphoria, that occur between ovulation and the onset of menstruation.


Presentation

Premenstrual syndrome presents itself with a combination of physical and emotional symptoms. These include:

Women with PMS do not experience all the above symptoms at the same time.

Fatigue
  • Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems. Depression.[mayoclinic.com]
  • Premenstrual syndrome describes a group of symptoms, including breast tenderness, headache, abdominal cramps, fatigue, mood swings, irritability and dysphoria, that occur between ovulation and the onset of menstruation.[symptoma.com]
  • Depression, chronic fatigue, and premenstrual syndrome often coexist in women seeking treatment for premenstrual distress.[ncbi.nlm.nih.gov]
  • The most common complaints are mood alteration and psychologic effects-irritability, nervousness, lack of control, agitation, anger, insomnia, difficulty in concentrating, lethargy, depression, and severe fatigue.[health.am]
  • "Elite athletes" (OR 8.63, 95% CI: 1.22-120.0), "Difficulty concentrating" (OR 3.15, 95% CI: 1.05-10.6), and "Fatigue or lack of energy" (OR 5.92, 95% CI: 1.32-34.5) increased the risk of poor athletic performance.[ncbi.nlm.nih.gov]
Weight Gain
  • The lesions coincided with a premenstrual syndrome, characterized by fluid retention-related symptoms, such as leg swelling, breast tenderness, bloatedness with abdominal girth variation and weight gain.[ncbi.nlm.nih.gov]
  • The most common physical and emotional signs and symptoms associated with premenstrual syndrome include: Weight gain from fluid retention Abdominal bloating Breast tenderness Tension or anxiety Depressed mood Crying spells Mood swings and irritability[web.archive.org]
  • The symptomatology of PMS is varied; it includes such psychological symptoms as irritability, depression, oversensitivity, mood swings and anxiety, in addition to such physical symptoms as water retention, breast tenderness, weight gain and migraines.[ncbi.nlm.nih.gov]
  • PMS Signs and Symptoms PMS has been characterized by more than 150 symptoms, ranging from mood swings to weight gain to acne. The symptoms vary from woman to woman and cycle to cycle.[healthcommunities.com]
  • gain and bloating; individuals may experience mood changes Physiological, emotional, and mental stress related to the period of time immediately preceding menstruation 625.4 Excludes menstrual migraine ( 346.4 ) Applies To Menstrual molimen Premenstrual[icd9data.com]
Deepening of Voice
  • Androgens Danazol (Danocrine) 100 to 400 mg twice daily 149 (120) Somewhat effective in alleviating mastalgia when taken during luteal phase Weight gain, decreased breast size, deepening of voice Continuous therapy is not recommended because of side effect[aafp.org]
  • Weight gain, decreased breast size, deepening of voice Monitor lipid profile and liver function.[web.archive.org]
Nausea
  • Trichomonas vaginalis was significantly correlated with headache and Gardnerella vaginalis with nausea.[ncbi.nlm.nih.gov]
  • Significant associations (P 0.05) were observed between the anxiety symptom and sodium (r 0,2630); and magnesium and depression (r 0,2508) and nauseas (r 2882). CONCLUSIONS: The anemia and hypocalcemia is a important nutritional problem.[ncbi.nlm.nih.gov]
  • Adverse effects are relatively frequent, the most common being nausea and asthenia. Adverse effects are dose-dependent.[ncbi.nlm.nih.gov]
  • Other nonspecific symptoms may include headache, vertigo, paresthesias of the extremities, syncope, palpitations, constipation, nausea, vomiting, and changes in appetite. Acne and neurodermatitis may also occur.[web.archive.org]
Abdominal Pain
  • The disorders can manifest with a wide variety of symptoms, including depression, mood lability, abdominal pain, breast tenderness, headache, and fatigue.[ncbi.nlm.nih.gov]
  • Definition of premenstrual syndrome : a varying group of symptoms manifested by some women prior to menstruation that may include emotional instability, irritability, insomnia, fatigue, anxiety, depression, headache, edema, and abdominal pain — called[merriam-webster.com]
  • pain/cramps Treatment guidelines full guidelines available from… National Association for Premenstrual Syndrome, 41 Old Road, East Peckham, Kent TN12 5AP ( – 0844 815 7311 ) The National Association for Premenstrual Syndrome (NAPS).[guidelines.co.uk]
  • pain The cause of premenstrual syndrome is unclear, but seems to be related to fluctuations in estrogen and progesterone levels in the body.[chop.edu]
Mitral Valve Prolapse
  • A woman with a long history of premenstrual tension syndrome (PMS) received verapamil for treatment of mitral valve prolapse.[ncbi.nlm.nih.gov]
Bruxism
  • We concluded that the excessive water retention caused a little widespread swelling, present at cheeks level also, that associated with a temporary bruxism (perhaps related to psychological stress typical of premenstrual syndrome) was probably responsible[ncbi.nlm.nih.gov]
Skin Plaque
  • […] of premenstrual syndrome: (i) typical premenstrual dysphoric disorder symptoms during ovulation; (ii) upper airway infection in the premenstrual phase that remits after onset of menstruation; (iii) recurrent perimenstrual erythematous and edematous skin[ncbi.nlm.nih.gov]
Joint Stiffness
  • stiffness Exacerbation of epilepsy, migraine, asthma, rhinitis or urticaria Abdominal pain/cramps Treatment guidelines full guidelines available from… National Association for Premenstrual Syndrome, 41 Old Road, East Peckham, Kent TN12 5AP ( – 0844 815[guidelines.co.uk]
Mastodynia
  • Water retention in the breast increases during this second, luteal phase, which is one of the main causes for the painful swelling of tissue inside the breast (mastodynia).[amitamin.com]
Decreased Libido
  • The most common side effects associated with a moderate dose of SSRIs were nausea (NNH 7), asthenia or decreased energy (NNH 9), somnolence (NNH 13), fatigue (NNH 14), decreased libido (NNH 14) and sweating (NNH 14).[ncbi.nlm.nih.gov]
  • libido/sexual frigidity , and emotional uproar .[project-aware.org]
  • Figures and Tables - Analysis 4.3 Comparison 4 SSRIs versus placebo: adverse events, Outcome 3 Sexual dysfunction or decreased libido.[doi.org]
Emotional Lability
  • We examined the relationship between impulsivity, aggressiveness/hostility, hopelessness, trait anger, affect intensity, emotional lability, and PMS/PMDD.[ncbi.nlm.nih.gov]
  • Premenstrual syndrome is characterized by irritability, anxiety, emotional lability, depression, edema, breast pain, and headaches, occurring during the 7 to 10 days before and usually ending a few hours after onset of menses. Diagnosis is clinical.[web.archive.org]
  • Mood is markedly depressed, and anxiety, irritability, and emotional lability are pronounced. Suicidal thoughts may be present. Interest in daily activities is greatly decreased.[merck.com]
Emotional Outbursts
  • Associated with verapamil therapy was a decreased severity in many symptoms of PMS, including agitation, depression, emotional outbursts, and irritability. A possible mechanism is discussed.[ncbi.nlm.nih.gov]
Auditory Hallucination
  • hallucinations and delusion of reference, present only premenstrually; and (vi) remitted bipolar disorder presenting with premenstrual psychotic features.[ncbi.nlm.nih.gov]
Emotional Outbursts
  • Associated with verapamil therapy was a decreased severity in many symptoms of PMS, including agitation, depression, emotional outbursts, and irritability. A possible mechanism is discussed.[ncbi.nlm.nih.gov]
Irritability
  • PMDD is a severe form of premenstrual syndrome with symptoms including severe depression, feelings of hopelessness, anger, anxiety, low self-esteem, difficulty concentrating, irritability and tension.[web.archive.org]
  • Tension and irritability were the most severe symptoms. Headache, irritability, self-deprecating thoughts, and depressed mood were the symptoms that were subjectively rated as the most burdensome.[ncbi.nlm.nih.gov]
  • Tranquilizers (eg, a benzodiazepine) may be used for irritability, nervousness, and lack of control, especially if patients cannot alter their stressful environments.[health.am]
  • SSRIs (eg, fluoxetine 20 mg po once/day) may be used to reduce anxiety, irritability, and other emotional symptoms, particularly if stress cannot be avoided. For some women, hormonal manipulation is effective.[web.archive.org]
Headache
  • Trichomonas vaginalis was significantly correlated with headache and Gardnerella vaginalis with nausea.[ncbi.nlm.nih.gov]
  • Other nonspecific symptoms may include headache, vertigo, paresthesias of the extremities, syncope, palpitations, constipation, nausea, vomiting, and changes in appetite. Acne and neurodermatitis may also occur.[web.archive.org]
  • […] the history relating the occurrence of cyclical mood and behaviour changes with menstruation, the improvement during pregnancy, postnatal depression and the presence of runs of many good days a month and the somatic symptoms of mastalgia, bloating and headaches[ncbi.nlm.nih.gov]
  • Premenstrual syndrome describes a group of symptoms, including breast tenderness, headache, abdominal cramps, fatigue, mood swings, irritability and dysphoria, that occur between ovulation and the onset of menstruation.[symptoma.com]

Workup

There are no particular diagnostic tools for diagnosing PMS. Women need to consult their gynecologist when they begin experiencing unusual symptoms prior to menstrual cycle. It is also advised that women maintain a record diary wherein they would keep track of all the symptoms experienced during the week before the menstrual cycle begins. It is also necessary that women also make note of the date of initiation of period and the date when it ends.

Hyponatremia
  • A small number of volunteers presented hypocalemia (1,4%), hyponatremia (4,22%) and hypernatremia (7,04%). However, the higher number of the volunteers presented lower calcium level (83,09%). The frequency of anemic women was high (24%).[ncbi.nlm.nih.gov]
Chlamydia Trachomatis
  • The following infectious agents were investigated: human papillomavirus, Chlamydia trachomatis, Neisseria gonorrheae, Gardnerella vaginalis, Candida albicans, and Trichomonas vaginalis.[ncbi.nlm.nih.gov]

Treatment

Medications form the preliminary and most important part of treatment regime [9]. The following is the list of medications that are prescribed for treating PMS:

In addition to medications, women are also advised to exercise regularly and stay physically active. Diet rich in vitamins and minerals and low in salt is also advised to avoid water retention during PMS.

Prognosis

Symptoms of PMS tend to get better with appropriate treatment. Medications and changes in life style have shown to play major role in improvement of PMS symptoms. However, a small percentage of women continue to suffer from severe symptoms until menopause.

Complications

The following are the complications associated with PMS:

Etiology

The exact cause of premenstrual syndrome is unknown. However, several factors that are known to play a significant role in development of PMS have been listed below:

  • Hormonal changes contribute significantly to PMS. The symptoms associated with hormonal fluctuations tend to go away during pregnancy and menopause [2].
  • Changes in the levels of serotonin in the brain are known to trigger several symptoms of PMS. Low production of this neurotransmitter is thought to give rise to depression, sleep problems, food cravings and mood swings before the onset of menstrual cycle.
  • Stress is one of the significant factors that can aggravate symptoms of premenstrual syndrome.
  • Faulty eating habits are also identified as one of the potential factors that can give rise to PMS. A diet low in vitamins and minerals, high in sodium and caffeine can pave way for development of PMS in many women.
  • Current researches has unearthed evidence that alterations in the endorphin release, gamma aminobutyric sytem, and production of prolactin may influence the occurrence of PMS [3].

Epidemiology

PMS is a very common condition and it has been estimated that 3 out of every 4 women are affected with this condition. In the United States, about 90% of women suffer from PMS at least once in their lifetime. Women who smokes has twice the propensity to develop severe PMS than non-smokers [4].

Sex distribution
Age distribution

Pathophysiology

Changes in the hormonal levels during the ovulation period are known to trigger premenstrual syndrome. A significant shift in the hormonal levels can cause drastic mood changes and can trigger symptoms of PMS. A diet that is low in magnesium and calcium can also trigger PMS. When nutritional supplements were given to menstruating women suffering from PMS, a significant improvement in the symptoms was noticed. Research has also found a strong link between deficiency of serotonin – brain chemical and PMS. PMS become totally non-existent beyond menopausal [5].

Prevention

An active lifestyle and a healthy diet can go a long way in preventing PMS. Staying physically active and exercising regularly can help keep several symptoms of PMS at bay [10]. A proper diet combined with regular exercise helps relieve stress, improves the energy levels and has a positive impact on the mood of the individual.

Summary

Premenstrual syndrome (PMS) refers to group of symptoms experienced at least a week before the menstrual period. Women in their late 20s and early 30s tend to experience these symptoms than their younger counterparts.

Emotional and physical symptoms are experienced during this period. However, the degree of intensity of these symptoms varies from one cycle to another. The symptoms begin approximately ten days before the commencement of the cycle and fade off either before the day or on the first day of the menstrual cycle. In some cases, women tend to experience severe symptoms prior to their menstrual cycle; such condition is referred to as premenstrual dysphoric disorder (PMDD) [1].

Patient Information

Definition

Premenstrual syndrome (PMS) is defined as group of symptoms that begins a week or two before the onset of menstrual cycle. The symptoms generally fade away with the commencement of menstruation. It is a common problem and is known to affect about 75% of women worldwide.

Cause

The exact cause that triggers PMS is not known. However, hormonal changes, poor dietary habits and lifestyle factors are known to play foul.

Symptoms

Women with PMS experience both emotional as well as physical symptoms which include breast tenderness, bloating, constipation or diarrhea, weight gain due to fluid retention, mood swings, depression, crying spells, fatigue, sleep problems, headache, joint aches, acne break outs and food cravings.

Diagnosis

There are no specialized diagnostic procedures to detect PMS. However, women are advised to visit their gynecologist once they experience some unusual symptoms prior to their regular periods.

Treatment

Medications form the basis of treatment regime. Antidepressants, NSAIDs, oral contraceptives and diuretics are prescribed to relieve the symptoms caused due to PMS. Adopting good dietary habits and following an active lifestyle also has a positive impact on PMS.

References

Article

  1. Freeman EW, Sondheimer SJ. Premenstrual Dysphoric Disorder: Recognition and Treatment. Primary Care Companion J Clin Psychiatry. 2003; 5:30-9.
  2. Yonkers KA, Brown C, Pearlstein TB, Foegh M, Sampson-Landers C, Rapkin A. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol. Sep 2005; 106(3):492-501.
  3. Emans SJ, Laufer MR, Goldstein DP. Premenstrual syndrome. In: Pediatric and Adolescent Gynecology. 5thed. Philadelphia, PA: Lippincott-Raven Inc; 2005:461-7
  4. Bertone-Johnson ER, Hankinson SE, Johnson SR, Manson JE. Cigarette Smoking and the Development of Premenstrual Syndrome. American Journal of Epidemiology. Jun 2008
  5. Masho SW, Adera T, South-Paul J. Obesity as a risk factor for premenstrual syndrome. J Psychosom Obstet Gynaecol. Mar 2005; 26(1):33-9.
  6. Freeman EW, DeRubeis RJ, Rickels K. Reliability and validity of a daily diary for premenstrual syndrome.Psychiatry Res. Nov 15 1996; 65(2):97-106.
  7. Steiner M, Korzekwa M, Lamont J, Wilkins A. Intermittent fluoxetine dosing in the treatment of women with premenstrual dysphoria. Psychopharmacol Bull. 1997; 33(4):771-4.
  8. Cleckner-Smith CS, Doughty AS, Grossman JA. Premenstrual symptoms. Prevalence and severity in an adolescent sample. J Adolesc Health. May 1998; 22(5):403-8.
  9. Sanfillipo JS, Muram D, Dewhurst J. Pediatric and Adolescent Gynecology. 2nd ed. 2001:433-50.
  10. Freeman EW. Therapeutic management of premenstrual syndrome. Expert Opin Pharmacother. Dec 2010; 11(17):2879-89.

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Last updated: 2019-07-11 21:02