Introduction

Premenstrual syndrome (PMS) can have a significant impact on a woman's daily life, affecting her relationships, work performance, and overall well-being.

PMS is a complex condition that can have a range of potential causes and consequences. 

By increasing awareness and understanding of PMS, women can better manage their symptoms and seek appropriate treatment and support when needed.

Let's Understand Premenstrual Syndrome

During the luteal phase of a woman's menstrual cycle, about a week or two before her period, many women suffer from a cluster of physical and emotional symptoms that are called Premenstrual Syndrome.

The symptoms can vary widely and may include mood swings, irritability, fatigue, bloating, breast tenderness, food cravings, headaches, and more.

Although the specific reasons for premenstrual syndrome are still unknown, it is associated with a change in estrogen and progesterone hormone levels.

Additionally, PMS can be a contributing factor to premenstrual dysphoric disorder (PMDD), a more severe form of PMS with debilitating symptoms.

With PMDD, you experience PMS symptoms but with much more intensity, especially when it comes to emotional responses and your mood.

You’re more likely to experience anger, severe depression, and anxiety with PMDD than with PMS. After your period starts, symptoms usually disappear within 2 to 3 days.

To treat your PMS symptoms, you may need to take medicine or a different kind of treatment. Always consult with a physician before taking medication.

PMS Causes

The exact cause of PMS is still unknown but research shows some factors play a key role:

Hormone Fluctuations: The levels of estrogens and progesterone vary greatly during the menstrual cycle. These changes, which may result in symptoms such as PMS, also can change your mood, energy levels, and body sensation.

The level of estrogen decreases sharply before the period, while progesterone levels may fluctuate. This drop in estrogen is often linked to mood swings and anxiety, while the progesterone dip might be linked to bloating and breast tenderness.

Brain Chemicals: Changes in the brain's chemicals such as serotonin, dopamine, and GABA cause PMS. Serotonin, for instance, regulates mood and appetite, and its decline before the period might contribute to depression, irritability, and cravings.

Other Factors:

Genetics: Some women are simply more susceptible to PMS due to their genes.

Lifestyle Factors: Diet, exercise, stress, and sleep can all impact PMS symptoms. Poor sleep or a diet high in sugar and processed foods might worsen symptoms.

Underlying conditions: Certain medical conditions, like depression and anxiety, can cause PMS.

The exact combination of factors causing PMS differs from person to person. Some women might be particularly sensitive to hormonal changes; others might have a genetic predisposition.

PMS Symptoms

There are a variety of symptoms of PMS that negatively impact your body and your emotional well-being.

The symptoms associated with PMS may vary with age. The symptoms you notice in your 20s may be different from the ones you will experience in your 30s and 40s.

Physical Symptoms include:

• Breast swelling and tenderness
• Acne
• Bloating and weight gain
• Headache
• Joint pain
• Backache
• Constipation or diarrhoea
• Food cravings.

Emotional and Behavioural Symptoms include:

• Irritability
• Mood swings
• Depression
• Anxiety
• Trouble with concentration and memory
• Increased conflict with loved ones
• Less interest in intercourse
• Decreased productivity

Diagnosis of PMS

Diagnosing premenstrual syndrome (PMS) is not based on a single test or symptom, but rather on a comprehensive evaluation by a healthcare professional.

Here's a detailed analysis of that process.

Medical history and assessment of symptoms: Your doctor will ask detailed questions related to your menstruation cycles, including the timing and extent of symptoms and the possible factors that may cause the PMS symptoms.

They will also ask you about your health, lifestyle, and existing medical conditions.

Physical examination: Usually, a pelvic examination is included to diagnose underlying conditions that may contribute to PMS symptoms

Tracking symptoms: It is always helpful to maintain a symptom diary for at least two menstrual cycles to help identify patterns and distinguish specific days when symptoms are most common.

Your doctor will be able to assess whether symptoms are indicative of PMS by looking at this information.

Eliminating any other conditions: Some medical conditions can share similar symptoms with PMS, such as thyroid disorders, depression, and anxiety.

Your doctor may start treatment of the underlying conditions. If these possibilities are not eliminated, your doctor may recommend additional tests or consultations.

PMS Treatment

Several strategies can help manage premenstrual syndrome symptoms:

Lifestyle modifications:

• Regular exercise and a healthy diet
• Stress management techniques like yoga or meditation
• Adequate sleep
• Limiting caffeine and alcohol intake
• Tracking symptoms to identify triggers

Medications:

• Pain relief from over-the-counter medicines may ease headaches and cramps
• Birth control pills can help regulate hormone levels
• Antidepressants may be helpful in extreme cases

Therapy:

• Cognitive-behavioral therapy (CBT) is useful to manage stress and negative thoughts associated with premenstrual syndrome
• Practicing relaxation techniques can reduce anxiety and improve sleep

Complications Related to PMS

If premenstrual syndrome is left untreated, symptoms may get worse and result in several problems, such as:

Reduced Overall Quality of Life: PMS symptoms can cause disruptions to relationships, everyday activities, and job performance, which lowers overall quality of life.

Mental Health Problems: Mental health disorders like anxiety and sadness may worsen. PMS-induced mood shifts may intensify pre-existing mental health conditions.

Chronic Pain: Dysmenorrhea, or severe menstrual cramps, is a common menstrual cycle condition for some women. This discomfort can last for a long time and it may be difficult to manage everyday tasks if we do not deal with it.

Relationship Stress: Untreated PMS can cause mood swings, impatience, and emotional shifts that can strain relationships with friends, family, and partners.

Enhanced Stress: Managing untreated PMS symptoms can cause continuous stress, which can have an impact on general health.

Health Complications: In certain instances, intense PMS symptoms may be a sign of an underlying medical disease, such as polycystic ovarian syndrome (PCOS) or endometriosis. If left untreated, these disorders may result in infertility or other problems.

FAQs

Is PMS preventable?

Premenstrual syndrome (PMS) is not preventable, however, it can be managed with changes in lifestyle, medicine, or a combination of both.

What is PME?

Premenstrual exacerbation (PME) is when premenstrual symptoms(PMS) get worse before your period starts. For example, bloating, breast tenderness, mood swings, irritability, or tiredness can get worse.

When do PMS symptoms begin?

The menstrual cycle takes approximately 28 days on average. If you've got an average-length cycle, at day 14, ovulation or the release of eggs from the ovaries starts.

PMS symptoms may occur at any time after ovulation, although they usually begin in the week before your period and last until 5 to 7 days after your period begins. 

Is PMS the same as PMDD?

PMDD is a more severe form of PMS characterized by extreme mood shifts, depression, and irritability that can significantly interfere with daily activities. It's less common, but more intense than PMS.

Can PMS affect fertility?

PMS itself doesn't affect fertility, but the symptoms may interfere with a woman's daily activities and quality of life.

Are PMS and menopause the same?

No, they're not the same. PMS (Premenstrual Syndrome) happens before a woman's monthly period and involves various physical and emotional symptoms.

Menopause is a stage marking the end of a woman's reproductive years, usually between the ages of 45-55, where periods stop and hormonal changes occur, leading to symptoms like hot flashes and mood swings.

What are the ways to treat premenstrual syndrome?

Making lifestyle changes such as exercising regularly, eating a balanced diet, getting good sleep, and managing stress can have a positive impact on our physical and mental well-being.

To alleviate physical symptoms, one can take over-the-counter pain relievers, or try herbal remedies like magnesium, or hormonal birth control pills. 

Conclusion

Understanding the causes and symptoms of PMS is crucial for empowering yourself with effective treatment options, even though it may present some challenges.

By embracing lifestyle changes, proactively seeking medical advice, and adopting a healthy diet intake habit, women have the power to significantly alleviate the impact of PMS on their daily lives.

Consulting with a healthcare professional can offer valuable personal guidance and support.​

References

• Women’s Health. (2021). Premenstrual Syndrome (PMS). Available at https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome.  (Accessed 14/12/ 2023)
  
• Cleveland Clinic. (2022). Premenstrual Syndrome. Available at https://my.clevelandclinic.org/health/diseases/24288-pms-premenstrual-syndrome.   (Accessed 14/12/2023)
• Healthline. (2022). Available at https://www.healthline.com/health/premenstrual-syndrome.  (Accessed 14/12/ 2023)
• Mayo Clinic. (2023). Premenstrual Syndrome. Available at https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/diagnosis-treatment/drc-20376787.  (Accessed 14/12/ 2023)
• ACOG. (2021). Premenstrual syndrome (PMS) Available at https://www.acog.org/womens-health/faqs/premenstrual-syndrome. 
• WebMed. (2023). What is PMS? Available at https://www.webmd.com/women/pms/what-is-pms. (Accessed 14/12/ 2023)
• Gudipally PR, Sharma GK. Premenstrual Syndrome. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560698/