Premenstrual Tension Syndrome

What is premenstrual syndrome?

Premenstrual syndrome (PMS) refers to a collection of physical and emotional symptoms that may occur a week or two before the start of a woman's menstrual period and disappear after the menstrual period begins. The repeated occurrence (cyclic) nature of PMS is the only way to separate PMS from other disorders. Ninety percent of all women report experiencing PMS symptoms at some time in their lives. For some women the symptoms are so severe that work and social relationships are seriously disrupted.

Though not completely understood, many theories exist for the cause of premenstrual syndrome. Although hormonal changes that occur throughout the menstrual cycle clearly influence PMS (especially those triggered by ovulation), an imbalance between estrogen and progesterone levels has not been consistently found. Some studies have reported a deficiency of serotonin (a chemical messenger in the brain) in women with PMS, which might explain a connection with behavior. Suggested theories that target deficiencies of vitamins E and B6, magnesium, or prostaglandins (a group of fatty acids, made naturally in the body, which act in a similar way to hormones) have not been confirmed.

How is it diagnosed?

History most frequently includes the following symptoms: anxiety, irritability, mood swings, tension, increased appetite, cravings (especially for sweets), poor concentration, confusion, crying, depression, forgetfulness, and withdrawal. Physical complaints include breast tenderness (with or without swelling), bloating, backache, fluid retention, weight gain, lower abdominal pain, dizziness, fatigue, headache (including migraine), insomnia, acne, palpitations of the heart (that feels like it is beating harder or faster than normal), and swollen joints.

Physical exam is not helpful to make this diagnosis.

Tests are not helpful.

How is premenstrual syndrome treated?

No single method of treatment has proven to be completely successful. Treatment also depends on the severity of the symptoms. Therefore, treatment is aimed at relieving the specific symptom.

• Weight gain, bloating, and swelling due to fluid retention may be relieved by reducing salt in the diet. Some relief is also reported from the use of calcium and magnesium supplements. If this is not helpful, a "water pill" (diuretic) may be needed to relieve fluid retention.
• Breast tenderness may be lessened by the use of a support bra, reduction in caffeine, and the use of vitamin B6 or oral contraceptives.
• Regular, daily exercise has been shown to help relieve symptoms of depression, tension, anxiety, fatigue, and irritability. Exercise also increases the release of endorphins (a group of substances formed within the body that relieves pain). Regular, moderate aerobic exercise has been found to be the most effective.
• Women experiencing sleep disturbances with PMS generally fall asleep easily, but awaken in the middle of the night. Sleeping pills can cause physical dependence and should be avoided. A mild antidepressant may prove effective.
• Headaches, backaches, and lower abdominal cramps can usually be relieved with pain medication (analgesics).
• Many women report improvement from changes in their diet. Guidelines include increasing complex carbohydrates (whole grains, fruits, vegetables, potatoes and pasta), while decreasing sugar, artificial sweeteners, salt, caffeine, and alcohol. Avoiding sugar and salt can lessen bloating and fluid retention. Reducing caffeine (including intake of coffee, tea, cola, and chocolate) can improve anxiety, irritability, nervousness, and insomnia. Reducing protein may also be helpful. Eating six small balanced meals instead of three large ones is also recommended.
• While stress does not cause premenstrual syndrome, it may intensify the symptoms. Relaxation techniques and exercise may help to relieve anxiety and tension.
• Hormonal treatment eliminates the normal menstrual cycle and can be effective. Estrogen taken by mouth or skin patch (transdermal) during menstruation may reduce symptoms. Birth control pills (oral contraceptives) using an estrogen and progesterone combination are another option. Progesterone supplements are controversial in that they do not help all women.
• The selective serotonin reuptake inhibitors (SSRIs) have recently been tried as a short duration treatment with each menstrual cycle and appear to be helpful.

Medications

Information	Brand	Generic	Label	Rating
	Paxil	Paroxetine
	Danocrine	Danazol
	Zoloft	Sertraline

Celexa (Citalopram), Prozac (Fluoxetine), Luvox (Fluvoxamine), Tofranil (Imipramine), Naprosyn (Naproxen), Aldactone (Spironolactone), BuSpar (Buspirone), Aygestin (Norethindrone), Xanax (Alprazolam)

What might complicate it?

Individuals with more severe symptoms may need additional medical intervention. Severe emotional symptoms can disrupt work and social relationships.

Predicted outcome

PMS symptoms usually subside with the onset of the monthly menstrual period. If symptoms persist longer, another diagnosis should be considered.

Alternatives

It could also be a depression of another type a response to stress, migraine headache, or anxiety disorder.

Appropriate specialists

Gynecologist and psychiatrist or psychologist.

Last updated 20 December 2011