Most women feel physical or mood changes during the days before menstruation. When these changes affect a woman’s normal life, they are known as premenstrual syndrome (PMS). Premenstrual syndrome can affect menstruating women of all ages and backgrounds.
The cause of PMS is unclear. However, the symptoms can be managed in many women.
what is PMS?
what symptoms are associated with the menstrual cycle?
Premenstrual symptoms are a common part of the monthly cycle. In fact, at least 85% of women who menstruate have at least one premenstrual symptom.
Women with PMS experience a pattern of symptoms month after month. They also find that the symptoms interfere with some aspect of their family, social, or work lives. Common symptoms occur during the 2 weeks before a woman’s period and they resolve as the period ends.
To understand PMS, it helps to know how the menstrual cycle works. This will help you to predict and cope with the symptoms. Menstruation is a normal, monthly process. The average menstrual cycle lasts about 28 days. Normal cycles can range from 21-35 days. During the menstrual cycle, the ovaries produce hormones. These hormones are called estrogen and progesterone.
what is a normal menstrual cycle?
Day 1 of the cycle is the first day of a period.
On about day 5, estrogen causes the lining of the uterus to build up to prepare for a pregnancy.
On about day 14, one of the ovaries releases an egg. This is called ovulation.
After ovulation, progesterone levels increase. If the egg is not fertilized by a sperm, the hormone levels decrease. This signals the uterus, to shed its lining on about day 28 of the cycle. This shedding, or menstruation, marks the start of a new cycle.
what are the symptoms associated with PMS?
increased nap taking
changes in sexual desire
thirst and appetite changes (food cravings)
bloating and weight gain
swelling of the hands or feet
aches and pains
To diagnose PMS a doctor must confirm a pattern of symptoms. These symptoms must:
be present in the 5 days before her period for at least 3 menstrual cycles in a row
end within 4 days after her period starts
interfere with some of her normal activities
Keep a menstrual diary by noting your emotional and physical symptoms and aligning with your cycel. You can use a period tracking app or simply write down in a notebook.
PMS or something else?
depression or anxiety disorder
These disorders are the most common conditions confused with PMS. The symptoms of depression and anxiety are much like the emotional symptoms of PMS. The symptoms of these disorders may simply worsen before or during a woman’s period. This makes some think they have PMS.
Symptoms of depressive disorders often are present all month long. With PMS, the symptoms go away after a period begins. Some women may have depression and PMS.
Women entering menopause may have PMS-like symptoms. These symptoms include mood changes and fatigue.
You can help your doctor decide if the symptoms are caused by menopause or PMS. A record of your symptoms and changes in your monthly cycle can be used to make a diagnosis.
other medical condition
Your health care provider will want to rule out other conditions that share symptoms with PMS. These conditions include chronic fatigue syndrome, irritable bowel syndrome, and some endocrine problems.
PMS may also make the symptoms of other conditions increase. These conditions include: seizure disorders, migraines and asthma.
management of premenstrual syndrome
hormonal birth control
Hormonal birth control pillsmay improve many of the physical symptoms by decreasing the amount of menstrual flow as well as pain.
By taking pills in a continuous regimen, woman can minimize the number of periods they get each year thus minimizing PMS.
Some women also find releif using a hormonal IUD such as Mirena.
Antidepressants, especially SSRIs such as fluoxetine (Prozac) or sertraline (Zoloft), can be helpful in treating PMS. These drugs can help lessen mood symptoms.
They are taken two weeks before the onset of the period or throughout the menstrual cycle.
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin or Advil (ibuprofen) or Aleve (naprosyn), can help reduce pain. These are most effective if taken when symptoms first begin as opposed to at their peak.
alternative options for treating PMS
Omega-3 fatty acids are the precursor of the potent anti-inflammatory and vasodilating eicosanoids.
Derived from fish oil at a dose of 2 grams per day has been shown to be effective in several studies. Beneficial eicosanoid precursors can be found in black currant oil, evening primrose oil, pumpkin, and flax seeds.
Dr Dunne's On-Line Formulary
Calcium deficiency has been linked to PMS. Studies have shown that ingesting 1,200 mg of calcium a day may help reduce physical and emotional symptoms of PMS.
When taking a supplement, not more than 500 mg per day. Food sources always best particularly dark leafy greens
Known for reducing bloating, breast tenderness, and mood symptoms.
Magnesium is a muscle relaxant, helping to diminish uterine contractility as a source of pain, as well as improving vascular flow.
Magnesium glycinate at 400 milligrams is helpful when taken once to twice daily starting several days before menses starts through the end of flow.
Studies have shown taking vitamin D during the luteal phase of the cycle can reduce the severity of PMS symptoms
involved in the production of neurotransmitters which play a big role in mood
Supplement with 50 to 100mg per day or you may choose a vitamin B complex
St John's wort
St John's wort has long been hailed as an alternative to antidepressants. It works on both serotonin and norepinephrine, two neurotransmitters that affect mood. It may help both the physical and emotional symptoms associated with PMS
Also known as Vitex, this is one of the most commonly used supplements for women's health. It may help bloating, breast pain and headaches
CAUTION: do not take if you have a hormone sensitive condition such as estrogen-receptor positive breast cancer
evening primrose oil
It is a rich source of omega-6 essential fatty acids particularly lineolic acid. It may help ease symptoms of PMS such as breast tenderenss, irritability, swelling and bloating
Aerobic exercise is anti-inflammatory, improves circulation, improves anxiety and depression, improves bowel function and estrogen metabolite elimination, and results in an outpouring of endogenous endorphins, our own natural pain relievers.
Similarly, orgasms have been promoted to have similar effects as exercise with the added benefit of directly increasing uterine circulation.
Stress management is an integral part of treating women with PMS, as their cyclic pain will surely contribute to angst and further dysfunction. Meditation, yoga, prayer, mindful awareness, and other stress-reduction efforts are an essential part of caring for women in pain.