Pre-menstrual Syndrome (PMS)

» Gynecological

Overview

Overview Premenstrual syndrome is defined as recurrent moderate psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation. Most women of reproductive age experience one or more mild emotional or physical symptoms for one to two days before the onset of menses. These symptoms, such as breast soreness and bloating, are mild and do not cause severe distress or functional impairment, and are not considered to represent premenstrual syndrome.

Definition
PMS: Recurrent psychological or somatic symptoms (or both) occurring specifically during the luteal phase of the menstrual cycle and which resolve in the follicular phase at least by the end of mensutruation
PMDD: Is the severe form of PMS in which symptoms of anger, irritability and internal tension are prominent.

Physiology of Menstruation

Female Reproductive Cycle

Watch Video Female Reproductive Cycle: Menstrual cycle

Signs and Symptoms

Clinical Features

Distressing psychological, physical and behavioral symptoms
Occurs during luteal phase of the menstrual cycle
Significant regression of symptoms with onset of or during the period (bleeding)

Physical Symptoms

Abdominal bloating
Body aches
Breast tenderness and/or fullness
Cramps, abdominal pain
Fatigue
Headaches
Nausea
Swelling of extremeties
Weight gain

Psychological and behavioural

Anger Irritability
Anxiety
Changes in appetitie
Changes in libido
Decreased concentration
Depressed Mood
Feeling out of control
Modd Swings
Poor sleeps
Tension

Investigations and Diagnosis

No need for investigation unless something sinister is suspected. It is important to make sure the signs and symptoms experienced by the woman are not occurring out side the luteal phase of the menstrual cycle. Also it is important to rule out other organise diseaes and significant psychiatric illness

Diagnosis Clinical history is key to the diagnosis of PMS or PMDD. Other affective disorders such as depression and anxiety may have premenstrual cyclic worsening, but do not have the symptom-free interval during the mid-follicular phase (days 6 through 10 of the menstrual cycle) needed for the clinical diagnosis of PMS or PMDD.

Pathophysiology

UNKNOWN

There do appear to be at least three components to the aetiology of PMS:

A brain component
An ovulatory menstrual cycle
Psychosocial factors and other factors Women who suffer from severe

PMS commonly date their problems from a bout of postnatal depression. Also, they typically have depressive side effects from progestogens such as medroxyprogesterone acetate, norethisterone and levonorgestrel.

Management

Hormonal Treatment

Combined Oral contraceptive pills
GnRH analogues

Non-Hormonal

SSRI/SNRIs
TCA

Remember Selective serotonin reuptake inhibitors are effective in relieving PMS symptoms.

Self managing strategies

Healthy diet
Vitamins and Minerals
Exercise
Stress reduction (yoga, tai-chi)
Cognitive Behavioural Therapy
Acupuncture
Herbal remedies
Mind-body therapy (aromatherapy, reflexology, magnotherapy)

Natural therapies that have positive evidence for the treatment of PMS

Vitamin B6

Calcium

Magnesium

Evening Primose Oik

Premular (an extract of the berries form the chaste tree)

St John's wart extract

Prognosis

Women with PMS and PMDD who begin medical therapy should be monitored at least every 3 months for efficacy of the treatment. The need for treatment continuation should be reviewed regularly.

Pre-Menstrual Dysmorphic Syndrome

Overview PMDD is a severe form of PMS. It occyrs in 8% of woman who are having their menstrual cycle. Genetic factors may play a role (daughters of mothers with PMDD are likely to have the disorder as well, identical twins 93%).

Risk Factors