Premenstrual Syndrome

What is premenstrual syndrome?

The term premenstrual syndrome (PMS) describes a variety of physical and emotional changes that may occur in a woman in the days before her menstrual period begins. This condition is very common, and affects the majority of menstruating women in one way or another. These changes include a low mood, increased appetite, tender breasts, mood changes, irritability and acne. The severity of symptoms varies from person to person. These symptoms tend to repeat in a predictable pattern before a period. Treatment involves lifestyle changes and medications which help to manage the menstrual cycle. Although PMS cannot be cured, the symptoms can usually be well managed.

Risks

The normal menstrual cycle is controlled by rising and falling levels of the hormones estrogen and progesterone. These hormones are responsible for developing and releasing the ova (eggs) and preparing the body for pregnancy, in the case that the egg becomes fertilized. If no fertilization occurs, menstrual bleeding occurs. Although the exact cause of premenstrual syndrome is not well understood, it’s likely that these changing hormone levels are responsible for the symptoms of premenstrual syndrome. This condition is very common, and affects the majority of menstruating women in one way or another.

Symptoms

Typical symptoms of PMS include emotional and physical symptoms. These vary widely from person to person, and may range from mild to causing problems with one's work or home life. Emotional symptoms include mood swings, irritability, sleeping difficulties, food cravings and poor concentration. Physical symptoms include bloating, breast tenderness, decreased energy, weight gain, nausea, swelling of the feet, impaired concentration and headaches.

Diagnosis

The diagnosis usually is made based on the symptoms and their relation to the menstrual period. Usually no tests are needed to confirm the diagnosis. A diary of symptoms can be helpful to make the diagnosis.

Treatment

The treatment involves managing the symptoms. This may be achieved by making lifestyle changes or with medications. Regular exercise, having a good support network and learning relaxation techniques may be helpful in reducing symptoms. Some medications are helpful, including the (oral contraceptive) pill, and low dose anti-depressant medications. In severe cases, surgical removal of the ovaries may be an option. This causes infertility, so it is most appropriate for women who are not planning to become pregnant.

Prevention

Keeping a symptom diary may help to recognize days in the cycle which are associated with worse symptoms, and being able to anticipate these may help to manage these better.