Premenstrual Syndrome (PMS): Symptoms, Causes and Treatment

Many women of childbearing age suffer from a common condition called Premenstrual Syndrome (PMS). According to experts, about 85% of all menstruating women are likely to experience at least one symptom of PMS in the course of their menstrual cycle. Usually, women experience mood swings, irritability, sensitivity to smell, fatigue and insomnia. They could also experience weight gain, acne and muscle pain.

Women experience PMS generally a week or two before their period begins, since the pain usually goes away when the bleeding begins or within the first four days of bleeding.

Who does PMS affect?

It is estimated that approximately 85 percent of all menstruating women will experience at least one symptom of PMS during their menstrual cycle. Women generally experience mild to severe symptoms of PMS which could be different in different cycles. Often, women may experience just one PMS symptom, but in the following months, they may not experience it at all. However, on the whole, three women out of four experience PMS at any one point of their menstruation. Those women who are more prone to experiencing these symptoms are generally:

• Between 20 years of age and early 40s
• Have one child at least
• Have a family history of depression
• Experience postpartum depression or any other kind of mood disorder

Symptoms

The symptoms of PMS are both physical and psychological.

Physical

• Muscle and joint pain
• Bloating and weight gain
• Fatigue and listlessness
• Headaches
• Stomach cramps and low back pain
• Swollen breasts and soreness
• Cravings for salty food or sweets
• Insomnia or oversleep
• Low sex drive
• Constipation or diarrhoea
• Acne

Psychological symptoms

• Sadness or depression
• Anxiety and mood swings
• Anger, irritability, aggressive behaviour
• Difficulty concentrating and low alertness level
• Social recluse

These symptoms differ in intensity and duration from woman to woman and from cycle to cycle and over time too. Women who suffer from PMS habitually will always depict the same symptoms from month to month.

Causes

The exact causes of PMS are not fully understood. However, it is thought that chemical and hormonal changes in a woman’s body are contributing factors. The initial cause may be accepted as hormonal changes, yet this condition is worsened by other symptoms, such as depression, emotional symptoms and fatigue. There are other contributory factors, such as insufficient amounts of minerals and vitamins and negative lifestyle habits such as eating overly salty food, and drinking alcohol and caffeine-based beverages.

Other causes

These include a low progesterone level, at the onset of menstruation, Vitamin B deficiency which causes oestrogen to be in excess in the body, causing an abnormality between the male and female hormones.

Poor renal condition is another factor which causes hypoglycemia or fluid retention in the body. This condition causes the adrenaline and calcium levels in the body to increase substantially, which hampers synthesizing serotonin. Lastly, if there’s an abnormal activity of the hormone prostaglandin, it could end up being a factor for PMS.

Diagnosis

Here is one medical condition that women diagnose by themselves without actually visiting a doctor. In fact, with the passage of time, as these symptoms turn up repetitively, women tend to recognize them as PMS symptoms and are ready to attend to them as such. Those close to these women may see a change in your behaviour.

How a doctor diagnoses PMS

If you report certain telltale symptoms of PMS to your doctor, he or she will be able to diagnose it. Diagnosing PMS involves your detailed medical history, checking to see if your period is regular, or if you have had any hormonal fluctuations, ovulation or any psychiatric problems like depression. It would help doctors immensely if you record your symptoms for a few months on a calendar to check if you have the same experiences every month. By doing this, your doctor can isolate depression from PMS.

How to prepare for your doctor’s appointment

In your quest for PMS relief, your first stop will be your family doctor’s clinic. So, when you ring for an appointment, you could be directed to a gynaecologist.

To prepare for your first appointment, do the following:

• When fixing the appointment, ask if you should do anything to be well-prepared for the meeting.
• Make a list of all your symptoms.
• List all your important medical information, including other problems for which you are on medication. List the names of medication, supplements and vitamins that you might be taking now.
• Think of all the questions you want to ask your doctor and note them down. Here are some questions you might want to ask your doctor:
• How can I minimize my symptoms of PMS?
• Is what I suffer from just PMS or something more serious?
• How long can I expect to suffer from PMS symptoms?
• What treatment do you recommend for my symptoms?
• Are there any alternatives to the medicines you prescribe for me?

What your doctor will ask you

Just as you have several questions to ask your doctor, he or she too may have many for you, if only to understand your condition better. Be prepared for these questions from your doctor:

• Are your symptoms unbearable or mild?
• On which days of your menstrual cycle do you find your symptoms at their severest?
• Are there any days of your menstrual cycle when you are absolutely free of PMS symptoms?
• Can you tell that you’re coming down with PMS?
• What makes your symptoms worse or what do you do to improve them?
• Are your symptoms so bad that your daily activities suffer?
• Do you feel depressed, irritable or listless during your menstrual period?
• Have you ever been diagnosed with a psychiatric problem? Does anyone in your family have a similar problem?
• Have you tried any treatments for this? How much success have you had?

Treatment and Prevention of PMS

Considering PMS isn’t fully understood, the best way to ease the pain it gives is to treat it in a holistic way, such as a combination of the following:

Medications

By taking the following medications, you can relieve your symptoms of PMS. These are:

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

By taking naproxen, ibuprofen, aspirin or ketoprogen just before your period, you can get relief from stomach cramps, discomfort in the breast, muscle and joint pain and headaches.

Oral contraceptive pills

Birth control pills also alleviate PMS symptoms by disallowing ovulation.

Hormonal contraceptives

Oestrogen-only patches and implants and synthetic hormones such as Gonadotrophin-releasing hormone (GnRH) analogues go a long way in bringing relief to PMS sufferers by stopping ovulation.

Antidepressants

Also known as Selective Serotonin Reuptake Inhibitors (SSRIs), these drugs can help manage any mental symptoms you suffer from, such as depression and anxiety, while also managing PMS. However, discuss this with your doctor before you start taking these pills.

Diuretics

Yet another treatment method for PMS is to reduce your salt intake so that the bloating you experience during PMS is negated by the body removing excess fluid from the kidneys.

Alternative therapies

You can also find relief in vitamin and mineral tablets or supplements with the following ingredients:

• Evening primrose oil
• John’s Wort
• Calcium
• Chasteberry
• Ginger
• Folic Acid
• Vitamins B-6, D and E
• Black Cohosh
• Magnesium
• Gingko

If you suffer from bloating and water retention during your periods, reduce your salt intake and take a mild diuretic that will urge you to urinate.

Complementary remedies

With complementary remedies, you can get relief from PMS symptoms faster. Try these methods:

• Calcium: Add 1200 mg of calcium to your diet as supplements to reduce the physical and mental effects of PMS.
• Magnesium: A further intake of 360 mg magnesium as a supplement will help reduce fluid retention, tenderness in the breasts and overall bloating.
• Vitamin E: Take 400 IU Vitamin E supplements per day to ease the pain of PMS. This will help reduce prostaglandin production which causes breast tenderness and stomach cramps.
• Herbal remedies: When women with PMS take herbal remedies like ginger, ginkgo, evening primrose oil, chaste berry and St. John’s Wort, they do find relief.
• Essential oils: Essential oils treat PMS very effectively by soothing you and relaxing you so that you are no longer irritable. These oils bring relief to users by minimizing mood swings, stomach cramps, low back ache, fatigue, bloating, food cravings and depression.

They can be applied directly to the skin, or can be used as warm compresses or as part of a warm and gentle bath. They can also be added to infusers, medicinal teas or inhalers.

Some essential oils you can use for relief from PMS are:

• Clary sage oil: This oil helps balance hormones naturally when rubbed on lower abdomen as a warm compress. They also relieve depression.
• Cypress oil: This helps get rid of water retention, while also improving circulation and relieving stomach cramps.
• Ylang Ylang oil: With ylang ylang oil, you can become tension-free as also get relief from cramping. You will no longer have mood swings with this oil. Use it in combination with lavender oil on the nape of your neck and lower stomach area.
• Peppermint oil: This oil relieves pain and any digestive complaints you might have like diarrhoea. Add three drops of this oil with a warm compress and get quick relief.
• Sage, jasmine and Neroli oil: Use any of these oils for relief from depression associated with PMS.
• Acupuncture: By going in for acupuncture, women are known to find relief from PMS.

Dietary changes

Reduce your intake of coffee, sugar and alcohol for relief from PMS. Eat several small meals through the day to reduce chances of bloating. Bloating and fluid retention can be negated by reducing salt in your diet. Increase the amount of water you drink through the day as this will keep you hydrated and negate the chances of fatigue and headaches. Also, remember to include a rich diet of fruits, veggies and whole grains, and foods rich in calcium and soya. These will get rid of any psychological and physical symptoms of PMS. Stop smoking and reduce caffeine and alcohol levels as they can make a difference to your energy levels and your mood.

Try this food guide for best results:

• Plant foods: If you eat more of fruits, veggies, nuts, herbs and seeds, your intensity of PMS symptoms can reduce considerably.
• High fibre foods: It’s important for all menstruating women to have an intake of a minimum of 30 gm of fibre per day to reduce GI disturbances caused by PMS.
• Green leafy vegetables: Green leafy veggies are diuretic in nature, apart from being a rich source of magnesium and calcium that play critical roles in reducing menstrual cramps.
• Flaxseed: These healthy seeds encourage the metabolism of oestrogen.
• Wild-caught fish: To reduce inflammation and pain, eat foods rich in Omega-3 fats.
• Avocado: Eat one avocado per day so that your hormones are in sync. This powerful fruit is a powerhouse of healthy fats, magnesium, fibre and potassium.

Exercise

Exercise regularly to reduce PMS-related stress along with agitation and nervousness. Do about 2.5 hours of exercise per week, preferably moderate intensity aerobics, such as cycling, walking and swimming. Regular exercise can also ease your fatigue and depression while Yoga, Pilates, breathing and stretching exercises can induce better sleep and reduce your stress levels.

Counselling

Speak to a counsellor and discuss your problems with her so that she may advise you on coping with PMS.

Symptoms journal

By maintaining a journal of your symptoms, your doctor can have a clearer idea of your psychological symptoms like depression and treat you accordingly.

Conclusion

PMS may be severe for you but don’t lose hope. There are several ways of reducing its intensity over time. If you persevere, you will find relief from all the ugly symptoms of PMS.

Resources

https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/diagnosis-treatment/drc-20376787

https://www.medicalnewstoday.com/articles/295123.php