Majority of the women complain about body pain, stomach ache, weight gain, anxiety,
depression, etc. before the onset of their monthly cycle. They know that they are feeling
and thinking differently, but have no control over these changes. However, during this
period of time, they not only undergo physical changes, but also experience emotional and
behavioural changes. These changes culminate into a series of symptoms and their severity
can affect quality of life by interfering with the routine activities, interpersonal relations or
social life. This overall phenomenon is termed as Premenstrual Syndrome (PMS). This article
briefly explains about this condition, its symptoms as well as the causes and risk factors
behind it.
What is Premenstrual Syndrome?
Premenstrual Syndrome is a common cyclic disorder in young and middle- aged women. Though there is no precise definition of
Premenstrual Syndrome, it is broadly described as any constellation of symptoms that occur in the luteal phase of the
menstrual cycle. In general, these symptoms occur 10- 12 days before the menstrual period begins and subside
completely with the commencement of menstrual bleeding. The term was first described by Frank and
Horney in 1931. They postulated the condition on the
basis of possible physiopathological origins and on
some forms of treatment. Later in early 1980s, Premenstrual Syndrome became a household term
and many articles were published to spread awareness among women to tackle the horrors
faced during this time of the month.
For centuries and still, Premenstrual Syndrome has not been taken very seriously. But, it is a real, repressive
problem for those who suffer from it and also to their loved ones. For some women, it is
just a minor problem, whereas in others, these changes can be severe enough to place
significant restrictions on daily activities and make it hard to even get through the day.
Women who have severe affective symptoms will often cry at the slightest issue without
any valid reason and sometimes, the world for them would seem completely negative.
Hence, due to severity, Premenstrual Syndrome is listed under "Diseases of the genitourinary system: Pain
and other conditions associated with female genital organs and menstrual cycle' by the
World Health Organization's (WHO) International Classification of Disease (ICD), 10 Revision.
Though, the true prevalence of Premenstrual Syndrome is unknown, from
retrospective community surveys, it is estimated that
around 90% of women have experienced at least one
Premenstrual Syndrome symptom in the menstrual phase of the cycle.
Approximately, 75-80% of the women of reproductive
age suffer from this syndrome. Premenstrual Syndrome may initiate at any
phase in a women's reproductive life cycle and about
one third to half of all women of childbearing age are
affected by this condition. Women over the age of 30
years are more prone to be affected by this condition.
The severity of Premenstrual Syndrome symptoms in women varies from cycle to cycle and it ranges from mild
to severe. Women with mild Premenstrual Syndrome experience clinical symptoms such as body ache, pain in
lower limbs, which do not affect psychological behaviour; whereas in case of severe Premenstrual Syndrome,
both the body and mind are affected in a way which impacts daily life. This severe form of
Premenstrual Syndrome is known as Premenstrual Dysphoric Disorder (PMDD) and around 3-8% women are
affected by this condition. It has been reported that up to 59.6% women dealing with Premenstrual Syndrome
symptoms would prefer treatment to cope up with this condition and around 28.8% seek
medical help. Most of the women manage these symptoms through lifestyle modifications
and conservative treatments.
What are the signs and symptoms of Premenstrual Syndrome?
Premenstrual Syndrome often produces physical as well as emotional or behavioural changes in a woman.
There are more than 200 symptoms of Premenstrual Syndrome or PMDD that are described ranging from
mild to severe. Severity of these symptoms
varies from one woman to another which can lead to difficulty in treating the condition. In fact, these
symptoms have also been documented to push some woman towards crime.
Few symptoms of Premenstrual Syndrome are listed below.
- Physical changes
- joint or muscle pain
- Swollen or tender breasts
- Stomach ache, headache or backache
- Digestive problems (bloating, constipation or
diarrhea)
- Acne
- Weight gain
- Fatigue
- Weakened immune system
- Emotional or behavioural changes
- Irritability
- Anxiety or Depression
- Emotional fluctuations
- Sleep disorder
- Change in sexual interest and desire
- Increase in appetite or food cravings
- Trouble with concentration or memory
What are the causes for Premenstrual Syndrome?
The exact cause of Premenstrual Syndrome remains unknown and yet there is no specific abnormality or
defect that has been identified. Despite many studies conducted, researchers are still
uncertain about the causes of Premenstrual Syndrome, though the general suspicion is - it may be complex or
multifactorial. In women with Premenstrual Syndrome, combination of a
variety of risk factors may affect the fine balance between
hormones and neurotransmitters. The factors
are as follows:
Hormonal changes
Hormones play a significant role in menstrual cycle.
They protect the female body from physiological
changes. However, imbalance in these can cause
genuine distress in women and can interfere with daily
functioning. These hormonal changes along with
chemical changes in the central nervous system (CNS)
are thought to be the most common causes that
contribute to Premenstrual Syndrome
progesterone and Estrogen are the two ovarian hormones that are involved in the
menstrual cycle. Levels of both of these hormones in the body are not same at all
times. Correct ratio of these hormones aids in good health. However, imbalance in
their levels can lead to physical pain and emotional disturbances. Their functionality
is generally in tandem to ensure sound health of the reproductive system. The appropriate
levels of these two are not only essential for a symptomfree menstruation but also have an
impact on other bodily functions. The levels of progesterone and estrogen in women with
Premenstrual Syndrome are shown to be same as compared to the unaffected ones. Some studies suggest the
possibility of affected women being more sensitive or harbouring abnormal response to
hormonal fluctuations.
Chemical changes
Interactions between neurotransmitters (chemical messengers in the brain) and
reproductive hormones along with their derivatives play an important and
complicated role in the activity of the hypothalamic- Heredity pituitary-adrenal (HPA) system.
This system controls Premenstrual Syndrome symptoms are often passed on from mother to functions like
reproduction, feeling of well-being, appetite and also regulates stress response. Therefore,
disturbances in these chemicals may be the underlying mechanisms that affect Premenstrual Syndrome.
Progesterone gets metabolised into its derivatives namely: allopregnenolone and pregnenolone,
Women suffering from past or current mental health Allopregnenolone acts as a gamma-aminobutyric
acid A(GABA) receptor positive allosteric modulator which
enhances the effect of GABA. This neurotransmitter
has anti-anxiety and relaxation properties.
Estrogen and progesterone play a crucial role in maintaining adequate amounts of neurotransmitters
like serotonin, dopamine and norepinephrine in the brain. Estrogen increases the production rate of
these neurotransmitters, while progesterone reduces their levels. Thus, increased or decreased
levels of ovarian hormones can also alter the levels of these neurotransmitters further causing Premenstrual Syndrome.
Serotonin is used in regulating mood and a number of other functions such as appetite,
memory, sexual urges, etc. Low levels are associated with depression and food cravings.
Norepinephrine is from catecholamine family and it enhances memory, promotes vigilance,
increases heart rate, blood pressure, etc.
Dopamine is associated with the pleasure system that improves feeling of relaxation and
motivation Depleted levels result in anxiety, tension, irritability, mood swings, etc. Dopamine
causes production of cortisol in response to stress and low levels of it are associated with
depression. Dopamine is also known as Prolactin. inhibitory factor due to its effect on prolactin
Endorphins are natural opiates produced by CNS and pituitary gland. These chemicals are
natural painkillers and also regulate pituitary hormones. Varying levels of these may cause Premenstrual Syndrome.
What are the Risk factors for Premenstrual Syndrome?
There are number of other factors which do not directly seem to cause
Premenstrual Syndrome but increase the risk for the same, which are:
Age
Women are more prone to Premenstrual Syndrome in their late 20s to early 40s and the condition worsens with
increasing age. Some women experience Premenstrual Syndrome symptoms in teens and early 20s while others
do not get it until 30 years of age.
Heredity
Premenstrual Syndrome symptoms are often passed on from mother to
daughter, but the intensity and symptoms vary. Thus,
family history of Premenstrual Syndrome can also put a woman at a higher risk.
Psychological factors
Women suffering from past or current mental health
conditions such as anxiety, depression, stress or other
related disorders are subjected to augmented
physiologic response, which may enhance symptoms of
Premenstrual Syndrome or PMDD and increase their risk.
Dietary and lifestyle factors
Poor eating habits are associated with Premenstrual Syndrome which include excess consumption of salty and
sugary foods. Eating lots of salty foods can cause water retention and further lead to bloating,
while foods with high sugar content are thought to be responsible for fatigue or mood changes.
Similarly, drinking alcohol and caffeinated beverages may alter your energy levels and cause
mood swings. Furthermore, insufficient intake of minerals such as calcium, Magnesium and
vitamins like thiamine, riboflavin can increase the risk of developing symptoms of Premenstrual Syndrome.
Sedentary lifestyle is also a known factor that can contribute to Premenstrual Syndrome.
Environmental factors
Environmental factors and situations like parental loss, childhood difficulties, lack of social
support and sexual abuse can increase risk of Premenstrual Syndrome.
Diagnosis of Premenstrual Syndrome
There are no specific Pathology Test or physical findings which can be used to diagnose
Premenstrual Syndrome. The medical provider diagnoses the condition based on
patient's medical and personal history. Also, the patient
is asked to maintain a menstrual diary to keep records
of the symptoms, menstruation and ovulation days; if
possible for over a period of 3 - 4 months. The symptoms
are divided into three parts including physical,
emotional and mental, and also the severity of
symptoms is expected to be recorded. If the symptoms
are seen to always appear 7 to 10 days prior to the
menstrual cycle, it is an indicative of Premenstrual Syndrome or PMDD
condition. It is also important to rule out other possible
conditions that may cause symptoms similar to that of
Premenstrual Syndrome. These include thyroid disorders, Diabetes, side
effects of contraceptive pills, etc. For e.g. Thyroid
Stimulating Hormone (TSH test) can be recommended
to diagnose thyroid problems. Further diagnosis of
PMDD is made on consultation with mental health
professionals.
Treatment and prevention
There is no cure for Premenstrual Syndrome and instead multiple ways can be recommended to
reduce its symptoms and impact on daily activities. Single treatment option does not work
for all women. For many women with mild Premenstrual Syndrome symptoms, few lifestyle adjustments like
dietary modifications, regular exercise, abstinence from alcohol or caffeine, adequate sleep,
managing stress ete. may be sufficient to control symptoms. Severe
symptoms of Premenstrual Syndrome cannot be treated with home
remedies and hence medications are prescribed in such
cases. Common medications that can be used to treat
Premenstrual Syndrome include nonsteroidal anti-inflammatory drugs
(NSAIDs) which aid in relieving pain. Oral contra
ceptives can help to eliminate Premenstrual Syndrome symptoms in some
women, but also has its own side effects. Similarly,
diuretics help get rid of the extra sodium and fluid in the
body which reduces bloating, abdominal and breast
pain. Antidepressants like selective serotonin reuptake
inhibitor (SSRI) and anti-anxiety drugs can be used to
regulate severe Premenstrual Syndrome symptoms such as depression or
mood swings. Supplements of minerals like calcium and
magnesium, and vitamins like vitamin B6, Folic acid,
vitamin D, vitamin E can be used to overcome
nutritional deficiencies which make Premenstrual Syndrome symptoms
worse.
Many women experience multiple symptoms during
their menstrual cycle. These abnormal Premenstrual Syndrome symptoms
could range from mild to severe conditions, showing
signs of imbalance, though natural and a routine for all
women, need to be managed with utmost care to avoid
affecting other facets of life.
