Last modified on May 22nd, 2020
Causes of Premenstrual SyndromePremenstrual syndrome is not due to a single factor. Genetic, environmental, and psychological are important factors in mood disorders as well as hormonal influence. Women have no PMS before puberty, during pregnancy or after menopause. These are times where ovarian hormone cycling has not begun or has ceased.
SymptomsThe types of symptoms and the degree of their severity vary markedly. A wide range of symptoms has been described but it is their timing and severity, namely that they significantly disrupt normal functioning, that are most important than the specific character in distinguishing those women with PMS from those with no more than physiological premenstrual symptoms.The most common physical symptom of PMS is fatigue. Another common symptom is oedema (fluid retention, with bloating or swelling in the abdomen, breasts, fingers and ankles and accompanying weight gain). Other physical symptoms may include headache, cramps, backache, joint and muscle pains, skin lesions (especially acne), constipation or diarrhoea, and a number of related disorders. Typical emotional and psychological symptoms of premenstrual syndrome range from irritability, anxiety, tension, lethargy, and rapid mood swings to hostility, confusion, aggression, and depression.
Premenstrual Dysphoric Disorder (PMDD)As with all biological parameters, for some women there are extreme premenstrual syndrome symptoms while others have minimal or no symptoms (5 – 10%). A similar number have such extreme symptoms that there is a major impact on their life, that of their family, their interpersonal relationships and normal day to day functioning. This is extreme premenstrual syndrome and is medically termed premenstrual dysphoric disorder (PMDD).Premenstrual dysphoric disorder (PMDD) affects approximately 3 to 9% of women, involving extreme and predominantly psychological mood changes. Women designated as having PMDD also fulfill criteria for PMS but not necessarily vice versa. While premenstrual dysphoric disorder is closelyrelated to major depressive disorder, the symptoms of severe depression are cyclical in nature, fluctuating with cycles of ovulation and menstruation. A distinguishing factor in the diagnosis of premenstrual dysphoric disorder is that depression eventually becomes so severe that home, work, and daily life are disrupted.
DiagnosisThere are no objective tests (physical, biochemical or endocrine) to assist in making a diagnosis. Therefore PMS is diagnosed by recording symptoms for several menstrual cycles in a symptoms chart. This is partly because the retrospective reporting of symptoms is inaccurate.There is also the fact that significant numbers of women who report PMS have other underlying problems. These may include perimenopause, thyroid disorder, migraine, chronic fatigue syndrome. Also, there are issues such psychiatric disorders such depression, panic disorders and anxiety disorder.Symptoms that occur in a predictable pattern (starting before menstruation, and then disappearing when it begins) are usual indicators of premenstrual syndrome. A doctor may perform a physical exam, if necessary, to rule out the possibility that symptoms indicate the presence of disease.
TreatmentTreatment of PMS involves finding the remedy or combination of remedies that work for each individual.
Medical TherapiesBroadly speaking, treatment of PMS should generally be achievable either by suppressing ovulation and the endocrine cycle either pharmacologically or by surgery or it may be achieved by altering the sensitivity to progesterone by elevating serotonin levels.Suppression of the ovarian cycle eliminates PMS effectively. This can be achieved by GnRH analogues with add back tibolone. Oestrogen also suppresses ovulation and eliminates PMS without menopausal side effects. Intrauterine progestagen (as levonorgestrel IUS) avoids re-stimulation of premenstrual syndrome at the same time that it protects the endometrium; it reduces periods and provides contraception.Other medications used to treat PMS include diuretics (to ease fluid retention), oral contraceptives (for hormone control), and anti-anxiety medication, for extreme irritability. SSRIs are the simplest and most effective non-hormonal approach to treatment. Some consider them to be first line medical therapy. Women with premenstrual dysphoric disorder usually require antidepressant medications.PMS can cause havoc in a woman’s sex life. Because the symptoms include emotional fluctuations as well as physical discomfort, neither the woman nor her partner knows what to expect. Some women find that their energy goes into symptom management, and they become self-absorbed. They tune in to their bodies but tune out their sexual feelings and, many times, their partners too.
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