Premenstrual Syndrome: Symptoms, Causes and Treatment
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Premenstrual Syndrome: Symptoms, Causes and Treatment

Post by on Sunday, December 12, 2021

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Many women feel physical or mood changes during the days before menstruation. When these symptoms happen month after month, and they affect a woman's normal life, they are known as premenstrual syndrome (PMS).

Emotional symptoms

·        Depression.

·        Angry outbursts.

·        Irritability.

·        Crying spells.

·        Anxiety.

·        Confusion.

·        Social withdrawal.

·        Poor concentration.

·        Insomnia.

·        Increased nap taking.

·        Changes in sexual desire.


Physical symptoms

·        Thirst and appetite changes (food cravings).

·        Breast tenderness.

·        Bloating and weight gain.

·        Headache.

·        Swelling of the hands or feet.

·        Aches and pain.

·        Fatigue.

·        Gastrointestinal symptoms.

·        Abdominal pain.


Who gets PMS?


As many as three in four women say they get PMS symptoms at some point in their lifetime. For most women, PMS symptoms are mild. Less than 5% of women of childbearing age get a more severe form of PMS, called premenstrual dysphoric disorder (PMDD). PMS may happen more often in women who:

·        Have high levels of stress.

·        Have a family history of depression.

·        Have a personal history of postpartum depression.  


Does PMS change with age?

Yes. PMS symptoms may get worse as you reach your late 30s or 40s and approach menopause and are in the transition to menopause, called perimenopause. This is especially true for women whose moods are sensitive to changing hormone levels during the menstrual cycle. In the years leading up to menopause, your hormone levels also go up and down in an unpredictable way as your body slowly transitions to menopause. You may get the same mood changes, or they may get worse. PMS stops after menopause when you no longer get a period.


What causes PMS?

No one knows for sure what causes PMS. As the symptoms start mid-cycle after ovulation (when the egg is released) it is thought that the hormonal changes which normally occur during each menstrual cycle may produce a variety of symptoms.

These hormonal changes (the main hormones are called estrogen and progesterone) affect women differently and can be further altered by lifestyle, hereditary factors, nutritional status, and the emotional state of the woman at the time when PMS symptoms appear. That is why some women have very mild symptoms and other women have severe symptoms impacting them for days at a time. 

More studies are being carried out to determine the cause of PMS. Many of the symptoms are similar to those experienced by women during pregnancy, and in the years before and during menopause.


How does PMS affect other health problems?

About half of women who need relief from PMS also have another health problem, which may get worse in the time before their menstrual period. These health problems share many symptoms with PMS and include:

?        Depression and anxiety disorders: These are the most common conditions that overlap with PMS. Depression and anxiety symptoms are similar to PMS and may get worse before or during your period.

?        Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): Some women report that their symptoms often get worse right before their period. Research shows that women with ME/CFS may also be more likely to have heavy menstrual bleeding and early or premature menopause.

?        Irritable bowel syndrome (IBS): IBS causes cramping, bloating, and gas. Your IBS symptoms may get worse right before your period.

?        Bladder pain syndrome: Women with bladder pain syndrome are more likely to have painful cramps during PMS.

PMS may also worsen some health problems, such as asthma, allergies, and migraines.

What dietary changes can be made to help relieve PMS symptoms?

?        Eat a diet rich in complex carbohydrates. A complex carbohydrate-rich diet may reduce mood symptoms and food cravings. Other examples are barley, brown rice, beans, and lentils.

?        Add calcium-rich foods, like yogurt and leafy green vegetables, to your diet.

?        Reduce your intake of fat, salt, and sugar.

?        Avoid caffeine and alcohol.

?        Change your eating schedule. Eat six small meals a day rather than three large ones, or eat slightly less at your three meals and add three light snacks. Keeping your blood sugar level stable will help with symptoms.


Can PMS be treated?


If your symptoms are mild to moderate, they often can be relieved by changes in lifestyle or diet. If your PMS symptoms begin to interfere with your life, you may decide to seek medical treatment. Treatment will depend on the severity of the problem.


Can exercise help lessen PMS symptoms?


For many women, regular aerobic exercises and meditation lessens PMS symptoms. It will reduce fatigue and depression. Aerobic exercise, which includes brisk walking, running, cycling, and swimming should be done. Exercise regularly, not just during the days that you have symptoms. A good goal is at least 30 minutes of exercise most days of the week.


What complementary or alternative medicines may help relieve PMS symptoms?


Some women report relief from their PMS symptoms with yoga or meditation. Others say herbal supplements help relieve symptoms. Talk with your doctor or nurse before taking any of these supplements. They may interact with other medicines you take, making your other medicine not work or cause dangerous side effects. The Food and Drug Administration (FDA) does not regulate herbal supplements at the same level that it regulates medicines.


Some research studies show relief from PMS symptoms with these herbal supplements, but other studies do not. Many herbal supplements should not be used with other medicines. Some herbal supplements women use to ease PMS symptoms include:

?        Black cohosh: The underground stems and root of black cohosh are used fresh or dried to make tea, capsules, pills, or liquid extracts. Black cohosh is most often used to help treat menopausal symptoms, and some women use it to help relieve PMS symptoms.

?        Chasteberry: Dried ripe chasteberry is used to prepare liquid extracts or pills that some women take to relieve PMS symptoms. Women taking hormonal birth control or hormone therapy for menopause symptoms should not take chasteberry.

?        Evening primrose oil. The oil is taken from the plant’s seeds and put into capsules. Some women report that the pill helps relieve PMS symptoms, but the research results are mixed.




A symptom diary: Treatment aims to relieve your particular symptoms. Keeping a daily record will help you clarify what your main symptoms are and when they occur. This information will help you and your doctor decide what treatment may suit you best. Make a note of things such as:

?        Whether you are taking an oral contraceptive?

?        What and when do you eat?

?        Whether you smoke, drink or take other recreational drugs, and if so, how much?

?        Your stress levels at work or home.

?        At what stage of your menstrual cycle do you first notice symptoms of PMS?

?        The amount and type of exercise you do.

?        See - symptom diary. 




Prescription medicines: Prescription medicines can also be helpful for women who have not been able to control their symptoms with lifestyle changes. Diuretics (water pills) have been given in the past to reduce the bloated feeling. This is not such a popular choice now, but is still prescribed occasionally. Some doctors prescribe hormones in the form of tablets.


Antidepressants: Antidepressants are another form of medication. Any medication requires regular medical supervision, so remember to have a six-monthly check-up with your doctor. If your symptoms do not improve or if they get worse, seek further assistance from your doctor.


Calcium or vitamin B6: Some women find calcium or vitamin B6 useful in controlling PMS symptoms. Calcium can be taken every day and vitamin B6 can be taken a few days before PMS symptoms start and continue until your period commences. Evidence from studies suggests the effective dose of calcium supplementation for PMS symptoms is about 1000mg per day; there is also some evidence that a calcium-rich diet may be beneficial for symptoms, e.g., four servings of low-fat dairy products a day.

Let your doctor know if you are taking either of these supplements

Dr. Dipti Mody


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