Pre-menstrual syndrome, or PMS for short, refers to a group of physical and emotional symptoms that many women experience in the days leading up to their menstrual period. These symptoms typically begin one to two weeks before menstruation and often resolve once menstruation begins.
PMS is a very common concern among women. Nearly 48 percent of women who are of reproductive age experience PMS, and for about 20 percent of them, symptoms are severe enough to affect their regular routine. While the exact causes of PMS are not fully understood, hormonal fluctuations during the menstrual cycle are thought to play a significant role in the development of the condition.
WHAT CAUSES PREMENSTRUAL SYNDROME?
As mentioned earlier, the exact cause of PMS is unknown. However, several factors have been suggested as possible contributors to the condition. These include:
- Hormonal fluctuations: Changes in levels of estrogen and progesterone during the menstrual cycle may contribute to the development of PMS symptoms.
- Chemical changes in the brain: Chemical changes in the brain, particularly changes in levels of serotonin, have been linked to the development of PMS symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.
- Environmental factors: Stress, lack of exercise, and poor diet have also been suggested as possible contributors to the development of PMS.
- Depression. Some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms
WHAT ARE THE SIGNS AND SYMPTOMS OF PREMENSTRUAL SYNDROME?
The symptoms of PMS can vary from person to person and can be physical, emotional, or behavioral. Some common symptoms of PMS include:
- Physical symptoms:
- Bloating
- Breast tenderness
- Fatigue
- Headaches
- Abdominal cramps
- Acne flare-ups
- Constipation or diarrhea
- Weight gain related to fluid retention
- Joint or muscle pain
- unusual sensitivity to light or sound
- unusual clumsiness
- Emotional symptoms:
- Mood swings and irritability or anger
- Crying spells
- Anxiety or Tension
- Depression or depressed mood
- Insomnia
- Reduced libido
- Behavioral symptoms:
- Food cravings
- Difficulty concentrating
- Social withdrawal
It’s important to note that not all women experience all of these symptoms, and the severity of symptoms can vary from cycle to cycle. Regardless of symptom severity, the signs and symptoms generally disappear within four days after the start of the menstrual period for most women.
HOW LONG DOES PMS LAST BEFORE YOU GET YOUR PERIOD?
The onset of PMS symptoms varies and is often a case-to-case basis. It is important to pay attention to your patterns. If you have PMS, you should notice symptoms within five days before starting your period. But the timing isn’t always exact. You may start to notice symptoms two weeks before your period or two days before your period.
HOW IS PREMENSTRUAL SYNDROME DIAGNOSED?
The diagnosis of PMS is usually based on the symptoms reported by the patient. A thorough history taking will be done by your physician, focusing especially on what symptoms you have, when you have them and how they impact your life. Remember though that it’s not uncommon to experience an unpleasant symptom or two occasionally before your period, but this isn’t the same as PMS.
To confirm that you have PMS, your physician will check if you have at least one symptom associated with PMS that occurs within five days of your menstrual cycle and then goes away within four days after your period ends. These symptoms must recur for at least three menstrual cycles for an official diagnosis.
It’s also important to keep a diary of symptoms for at least two menstrual cycles to help identify patterns and determine whether the symptoms are related to the menstrual cycle. In some cases, additional tests such as blood tests, ultrasound, or laparoscopy may be needed to rule out other underlying conditions that can cause similar symptoms.
About The Author
Dr. Hannah is a highly-skilled and compassionate physician who completed her medical degree at Pamantasan ng Lungsod ng Maynila in 2014. She passed the Physician Licensure Exam in 2015, and has since gained experience working in various hospitals and clinics throughout Metro Manila. For three years, she served as a physician on duty at a dialysis institute, caring for patients with chronic lifestyle diseases.
As a primary care physician, Dr. Hannah is dedicated to providing patient-centered care that takes into account the whole person, not just their illness. She believes in empowering her patients to take an active role in their healthcare, and believes that this type of doctor-patient relationship is key to achieving optimal health.
WHAT ARE THE COMPLICATIONS OF PMS?
For most women, PMS symptoms are mild to moderate and do not significantly impact their daily lives. However, in some cases, PMS symptoms can be severe enough to interfere with daily activities, work, or relationships. Severe PMS symptoms may be a sign of a more serious condition called premenstrual dysphoric disorder (PMDD). PMDD is a severe and potentially debilitating form of PMS. Around 2% of people who menstruate have PMDD. With PMDD, you experience PMS symptoms but with much more intensity, especially when it comes to emotional responses and your mood. You’re more likely to experience anger, severe depression and anxiety with PMDD than with PMS.
HOW CAN I MANAGE SYMPTOMS?
For many women, lifestyle changes alone can help relieve PMS symptoms. But depending on the severity of your symptoms, your physician may prescribe one or more medications for premenstrual syndrome. The effectiveness of medications in relieving the symptoms of PMS varies among women. Commonly prescribed medications for premenstrual syndrome include:
- Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are the first line treatment for severe PMS or PMDD. Some SSRIs like fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and others have been successful in reducing mood symptoms.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Taken before or at the onset of your period, NSAIDs such as ibuprofen or naproxen sodium can ease cramping, headaches and breast discomfort.
- Hormonal contraceptives. Hormonal contraceptives such as birth control pills, patches, or vaginal rings can help regulate hormone levels and reduce the severity of PMS symptoms.
Lifestyle and home remedies
Sometimes, lifestyle changes alone can reduce the symptoms of premenstrual syndrome. These modifications include changes in the way you eat, exercise and approach daily life. Here are some tips that you can try:
Modify your diet
- Eat smaller, more-frequent meals to reduce bloating and the sensation of fullness.
- Eat fewer salty, fatty, and sugary foods, and drink fewer caffeinated and alcoholic beverages two weeks before your period. This would reduce bloating and fluid retention.
- Choose foods high in complex carbohydrates, such as fruits, vegetables and whole grains.
- Choose foods rich in calcium. If you can’t tolerate dairy products or aren’t getting adequate calcium in your diet, a daily calcium supplement may help.
- Avoid caffeine and alcohol.
Incorporate exercise into your regular routine
- Engage in at least 30 minutes of brisk walking, cycling, swimming or other aerobic activity most days of the week. Regular daily exercise can help improve your overall health and alleviate certain symptoms, such as fatigue and a depressed mood.
Reduce stress
- Get plenty of sleep. Getting at least eight hours of sleep can reduce feelings of irritability. Waking up and going to bed at the same time each day adds the extra benefit of syncing your internal clock so that you’re less likely to feel moody throughout the day.
- Practice progressive muscle relaxation or deep-breathing exercises to help reduce headaches, anxiety or trouble sleeping (insomnia).
- Try yoga or massage to relax and relieve stress.
- Record your symptoms for a few months
- Keep a record to identify the triggers and timing of your symptoms. This will allow you to intervene with strategies that may help to lessen them.
Alternative Therapies
Some women may find relief from PMS symptoms through alternative therapies such as vitamin supplements, herbal remedies, acupuncture, or even massage. Here are some examples of alternative therapies for PMS:
- Vitamin supplements. Calcium, magnesium, omega 3 and 6, vitamin E and vitamin B-6 have all been reported to soothe symptoms, but evidence is limited or lacking.
- Herbal remedies. Several herbal remedies have reportedly helped relieve PMS symptoms, although few scientific studies have attested to their effectiveness. Herbs such as ginkgo, ginger, chasteberry (Vitex agnus), evening primrose oil and St. John’s wort have all been used for PMS. However, herbal remedies also aren’t regulated by the Food and Drug Administration, so there’s no record of product safety or effectiveness. Therefore, it is recommended that you talk with your doctor first before taking any herbal products, as they may have side effects or interact with other medications you’re taking. St. John’s wort, for example, reduces the effectiveness of birth control pills.
- Acupuncture. A practitioner of acupuncture inserts sterilized stainless steel needles into the skin at specific points on the body. Some women experience symptom relief after acupuncture treatment.
- Cognitive behavioral therapy (CBT). If you have severe mood symptoms that create complications in your daily life, CBT or other therapy approaches can help you learn new ways to reframe and cope with distressing thoughts and emotions.
THE BOTTOM LINE
In conclusion, PMS is a common condition that affects many women in the days leading up to their menstrual period. The symptoms of PMS as well as its severity can vary from person to person and can be physical, emotional, or behavioral. If you are experiencing symptoms of PMS, it’s important to seek help from a healthcare provider. Your healthcare provider can work with you to determine the best treatment options for your individual needs. Remember, PMS is a common condition that affects many women, and there are several options available to help manage and alleviate symptoms. Don’t suffer in silence – speak up and take action to improve your quality of life.
About The Author
Dr. Hannah is a highly-skilled and compassionate physician who completed her medical degree at Pamantasan ng Lungsod ng Maynila in 2014. She passed the Physician Licensure Exam in 2015, and has since gained experience working in various hospitals and clinics throughout Metro Manila. For three years, she served as a physician on duty at a dialysis institute, caring for patients with chronic lifestyle diseases.
As a primary care physician, Dr. Hannah is dedicated to providing patient-centered care that takes into account the whole person, not just their illness. She believes in empowering her patients to take an active role in their healthcare, and believes that this type of doctor-patient relationship is key to achieving optimal health.
