Premenstrual syndrome (PMS) refers to a wide variety of symptoms that many women experience in the lead up to their menstruation. Symptoms tend to recur in a predictable pattern, but always resolve post menstruation. To classify symptoms as PMS, a woman must have at least one symptom- free week before the symptoms return. If a woman’s symptoms continue after her period, then the cause may be something other than PMS, like depression, approaching menopause or thyroid dysfunction. PMS can often worsen when a woman is in her thirties and may continue to be a problem until menopause.
It is thought that at least 3 out of 4 women who menstruate will have premenstrual symptoms. The symptoms can range in severity from relatively mild (in 75 per cent of women) to severe (in 20 to 30 per cent of women). For 8 per cent of women with severe symptoms, PMS is associated with reduced quality of life.
PMS is a complex condition that includes physical and emotional symptoms. Although the cause is not conclusively known, the latest research shows that:
- women with PMS are hypersensitive to their own normal cyclic hormones (oestrogen and progesterone) during a menstrual cycle
- ovulation is required with the release of oestrogen and progesterone
- genes specific to oestrogen are involved
- there is involvement of neurotransmitters like serotonin and gamma butyric acid
- there is a resolution of symptoms during pregnancy or after menopause.
Symptoms of PMS can be divided into emotional and, behavioural or physical. Emotional symptoms include mood swings, irritability and depression, food cravings, social withdrawal and insomnia. Physical symptoms can include tender breasts, fatigue, bloating and joint and muscular pains. Between three and eight per cent of menstruating women can suffer from severely debilitating PMS, which is also known as premenstrual dysphoric disorder (PMDD). These symptoms can have a serious impact on a woman’s mental health and can be severe enough to affect her ability to carry out her normal activities
There are no specific diagnostic tests for PMS, it is usually made clinically, through the patient’s history and presenting symptoms.
Treatment for PMS includes lifestyle and diet modification, supplements, and medication. Supplements including calcium, vitamin D, evening primrose oil, lemon balm, curcumin, vitamin B6, isoflavones, St John’s wort and wheatgerm have been shown to provide some benefit.
Effective therapy targets reduction of oestrogen load during the luteal phase in a woman’s cycle. Cycling progesterone therapy has proven to be highly successful in treating symptoms of PMS. Adjunct medication to reduce oestrogen production can also provide further relief. Each woman’s needs are highly specific and these need to be assessed on an individual basis.