Premenstrual syndrome

By Khor Su Lin (CARiNG Pharmacist) | Malaysia | Thu Nov 19, 2015 11:29am

Premenstrual syndrome
Premenstrual syndrome, commonly called PMS, is defined as "the cyclic occurrence of symptoms that are sufficiently severe to interfere with some aspects of life, and that appear with consistent and predictable relationship to the menses." It is a medical condition causing a variety of physical and psychological symptoms that affect many women of childbearing age.

The exact cause of PMS is unknown, but it seems to be related to the cyclical fluctuation of hormones, including estrogen and progesterone, that occur in preparation for menstruation. Women with premenstrual syndrome may respond differently to these hormones.

In addition, research has shown that the likelihood of PMS is increased in women who are obese – a body mass index (BMI) over 30, and in women who do little exercise.  Some women find that their PMS is worsen when stressed.

PMS consists of a set of symptoms that tend to:
• Start during the second half of the menstrual cycle (14 days or more after the first day
  of the last menstrual period)
• Go away within 1 – 2 days after a menstrual period starts

The most common physical symptoms include:
• Bloating
• Breast tenderness
• Acne
• Constipation or diarrhea
• Headaches or backaches
• Food cravings or overeating
• Confusion or difficulty concentrating
• Fatigue and feeling slow or sluggish
• Feelings of tension or anxiety
• Mood swings
• Sleep problems (sleeping too much or too little)
• Loss of sex drive (may be increased in some women)

There are no specific signs or laboratory tests that can be used to diagnose PMS. To rule out other possible causes of symptoms, it is important to have a:
• Complete medical history
• Physical examination (including pelvic examination)
• PMS symptoms diary. A diary is a helpful tool for better understanding of your premenstrual symptoms,
  hence facilitating the diagnosis and treatments of PMS. It is recommended to keep a diary of your
  PMS symptoms for two or three consecutive months, when they occur, and how long they last.
  Eventually, the correspondence of symptoms to certain times in your monthly cycle can be seen.

1. Lifestyle modifications
    A healthy lifestyle is the first approach to managing PMS. Most often, lifestyle approaches are
    sufficient to control symptoms.
• Drink plenty of fluids (water or juice but not soft drinks, alcohol, or other beverages with caffeine)
  to avoid dehydration – being dehydrated can worsen headache and tiredness
• Reduce caffeine intake, refined sugar and sodium intake, at least during the premenstrual phase
  of your cycle. These substances might cause emotional and physical PMS symptoms, such as
  insomnia, tension and anxiety, food cravings, and bloating.
• Eat frequent, but smaller meals, and avoid overeating
• Eat a balanced diet with extra whole grains, vegetables, and fruit, and less or no salt and sugar
• Get regular exercise (e.g. walking, swimming and cycling) throughout the month to improve
  your overall health
• Learning techniques to help relief stress (e.g. listening to music, doing yoga, massage etc)
• Get sufficient rest and regular sleep

2. Medications
• NSAIDs such as aspirin, ibuprofen, naproxen may alleviate headache, backache, menstrual cramp
  and breast tenderness. NSAIDs work best when taken before and continued at regular dosage
  intervals throughout the premenstrual pain period. For some women, intake of NSAID may need
  to be continued to the first day of menstrual bleeding, to relieve painful cramps.  
• Birth control pills might be prescribed but they may decrease or increase PMS symptoms
• On the other hand, medicines to treat depression may be prescribed by healthcare provider for
  moderate to severe premenstrual symptoms (often known as Prementrual Dysphoric Disorder, PMDD),
  including aggression, depression, anxiety, and physical symptoms. Antidepressants known as selective
  serotonin-reuptake inhibitors (SSRIs) are often tried first.
• Other medicines like diuretics may be used to help with severe fluid retention, which causes bloating,
  breast tenderness, and weight gain.

It is recommended to talk to your health care provider if you are finding it difficult to deal with the symptoms of PMS. They can help determine the severity of your PMS and may be able to offer you proper advice and treatment to manage the symptoms you are experiencing.




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