Premenstrual Syndrome (PMS)

Clinical Features of PMS

File photo. | Credit: Women's Health Opens in new window Most women experience some discomfort just before the menstrual period, most commonly breast tenderness, food cravings, and pelvic heaviness or bloating.

Often experiencing PMS may do and say things that alienate friends and family. Negative self-images may develop as these women attempt to cope with severe PMS symptoms.

Premenstrual dysphoric disorder (PMDD)Opens in new window is a more severe form of PMS. PMDD includes all of the physical symptoms of PMS with additional and more debilitating emotional symptoms. Appropriately 3% to 8% of menstruating women experience PMDD (Yonkers & Casper, 2013).

Symptoms of PMS usually resolve with the onset of the woman’s menses. However, it is unclear why some women experience PMS while others do not. Worldwide, women report similar symptoms that occur with PMS but in some countries the women do not report having PMS as that term does not exist in their language. Due to these factors, 85% of women report having one of the symptoms of PMS (Yonkers & Casper, 2013).

Although the exact causes of PMS remain unknown, research shows that PMS symptoms are very complex and do not arise from one single causal factor. In fact, PMS results from the interplay between the central nervous system, the endocrine system, and other factors, such as genetics.

Clinical Manifestations

PMS presents with a wide variety of symptoms, which may be physical, behavioral, or both. The symptoms can be highly distressing for the woman and her family. In making a diagnosis of PMS, the crucial component is the cyclical nature of the symptoms.

Table X-1 lists the common physical and behavioral symptoms used for the diagnosis of PMS. Typically, the severity of symptoms progresses over time.

In the early stages of PMS, women describe symptoms beginning a few days before their period start that stop when bleeding begins. With time, symptoms begin to appear one to two weeks before the onset of menses.

Some women describe a cluster of symptoms occurring at the time of ovulation, followed by a symptom-free week, then a recurrence of symptoms a week before menses. PMS does not necessarily indicate dysmenorrheal will occur. Many women with symptoms of PMS do not have pain with menses.

Criteria the practitioner use to make a diagnosis of PMS include the following:

• The woman has at least one physical and one behavioral symptom occurring during the last half of the menstrual cycle.
• The woman in asymptomatic before ovulation, and has at least seven symptom-free days in each cycle.
• Symptoms reported must be severe enough to affect relationships, work, and daily lifestyle.

A normal menstrual cycle varies from 21 to 35 days, and is considered to be regular if variations, cycle to cycle, do not exceed 4 days. Normal menstruation may last from 2 to 8 days, with the bleeding being pink, bright red, or dark brown. The normal age of menarche Opens in new window is from 12 to 14 years, but the age does vary with race, economic, and social factors.

Early menarche is usual in the blind, deaf, and congenitally physically handicapped (hydrocephalus, spina bifida, dislocated hip). The normal age of menopause Opens in new window is between 45 and 55 years, therefore if menstruation stops before the age of 45 years, or if bleeding becomes heavy then gynecological examination is indicated.

Cyclical symptoms may occur for up to 2 years before the menarche, and up to 2 years after the menopause. Following recovery from the trauma of hysterectomy or bilateral oophorectomy, cyclical symptoms return.

Treatment

PregnancyOpens in new window and menopauseOpens in new window are the only true cures for PMS. Treatment aims to alleviate specific signs and symptoms. Some studies show that supplementation with vitamin B₆, calcium, and magnesium are beneficial.

Medications may be used to help relieve the symptoms of PMS. These include diuretics to reduce bloating, NSAIDs to reduce pain and cramping, and antianxieyt drugs or antidepressants. Stress reduction, relaxation therapy, and exercise may also provide the woman with some relief. Some women report relief of PMS after starting oral contraceptives.

PMDDOpens in new window responds to treatments similar to those used for PMS. In addition, the use of selective serotonin reuptake inhibitiors (SSRIs) during the last half of the cycle has been effective in treating the severe mood swings and other emotional symptoms that are seen in PMDD.