The Medical Health Plus

Premenstrual syndrome (PMS)

Premenstrual syndrome (PMS) refers to a wide range of physical, psychological or emotional symptoms that typically occur between ovulation and the onset of menstruation. It usually occurs about 5 to 11 days before a woman starts her monthly menstrual cycle. The symptoms usually stop when menstruation begins, or shortly thereafter. PMS encompasses symptoms severe enough to interfere with daily life, these symptoms can last 4–10 days and can have a substantial impact on a woman’s life.

Several theories have been proposed to explain why PMS occurs. The most popular explanation for PMS is that these symptoms are related to cyclic changes in female sex hormones, pituitary hormones, prostaglandins and certain brain chemicals known as neurotransmitters. Some researchers have suggested that PMS may be related to abnormally low blood sugar (hypoglycemia), abnormally low levels of thyroid hormones (hypothyroidism) or a diet low in B vitamins, calcium or magnesium.

It is believed that lifestyle may play a significant role in PMS. This is because PMS symptoms appear to be most troubling in women who smoke, lead stressful lives, rarely exercise, sleep too little or whose diet is high in caffeine, alcohol, salt, red meat or sugary foods such as chocolate or candy. However, it’s not clear whether these factors increase your risk of PMS or if PMS accounts for these differences in lifestyle.

Causes of PMS

An exact cause of PMS has not been identified. It is generally believed that symptoms result from the waning hormone secretions from the ovaries as the corpus luteum begins to degenerate towards the end of the menstrual cycle. At these stage concentrations of progesterone and estrogen in the circulating blood decline, and this is thought to precipitate the various symptoms. How the loss of these hormone secretions results in the physical, behavioural, and psychological symptoms ranging, for example, from abdominal bloating to food cravings and lethargy remains unknown, as does the question as to why some women should suffer from PMS while others do not. Theories have been proposed regarding the ratio of estrogen to progesterone secretions or the absolute concentrations of these hormones, but these have not been consistently validated. More likely, the cause is an individual’s response to her changing hormone secretions, which may be exacerbated by social, cultural, biological, and psychological factors.

PMS is estimated to affect up to 75% of women during their childbearing years.

It occurs more often in women:

· Between their late 20s and early 40s

· Who have at least one child

· With a family history of a major depression

· With a history of postpartum depression or an affective mood disorder

The symptoms typically get worse in the late 30s and 40s as a woman approaches the transition to menopause.

As many as 50-60% of women with severe PMS have an underlying psychiatric disorder (premenstrual dysphonic disorder).

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Symptoms of PMS

Specific symptoms of PMS vary from woman to woman, the top three complaints seem to be irritability, fatigue, and bloating.

Symptoms of PMS fall into two general categories:

* Physical symptoms

* Psychological and emotional symptoms

Physical symptoms includes: Bloating, Breast tenderness, Swelling of feet and ankles, Fluid retention and weight gain, Painful uterine cramps just before and during the first few days of menstruation, Headaches, Food cravings (especially for salty or sweet foods), Acne breakout, Low energy or fatigue, Palpitations, Dizziness, Backaches or muscle pain

Psychological and emotional symptoms: Fatigue, Mood swings, Irritability, Depression, Aggressiveness or hostility, crying spells, Difficulty concentrating, increased appetite, Forgetfulness, Changes in libido (sexual desire)

Prevention of PMS

Maintaining a good diet, one low in sugars, salt, fats, alcohol, and caffeine, and high in phytoestrogens and complex carbohydrates, may prevent some of the symptoms of PMS. Consumption of more complex carbohydrates may relieve PMS symptoms since carbohydrates drop serotonin levels as they raise insulin levels. For instance, two cups of cereal or a cup of pasta has enough carbohydrate to effectively increase serotonin levels. Carbohydrates also provide steady levels of blood sugar and act to stabilize one’s mood. One recommendation is to eat 100 calories of complex carbohydrates every three hours beginning one week before menstruation. Complex carbohydrates include whole wheat bread and pasta, brown rice, and whole grain foods. Caution should be taken due to the fact that a high carbohydrate diet causes water retention, which in turn is a symptom of PMS.

Women with PMS can benefit by boosting levels of specific nutrients.

* Magnesium deficiency is common among women with PMS. Ideally, take 400 mg/day but, in one trial, just 200 mg/day for two months significantly reduced fluid retention, weight gain, oedema, breast tenderness and abdominal bloating

* Vitamin B6 (50-400 mg daily) can relieve symptoms of PMS if taken for several months. Some women, however, may experience gastrointestinal problems with doses above 200 mg per day.

* Women who consume more dietary calcium are less likely to suffer severe PMS. Supplements can also help 1200 mg/day can reduce PMS symptoms by 48 per cent.

* Potassium is similarly helpful. Taking 600 mg of potassium gluconate daily can relieve symptoms of bloating, fatigue and irritability. The full effect of potassium takes around four cycles to produce results.

Treatments that can help PMS are listed below

· Get enough sleep at the right time. Be in bed and asleep before 10:30pm and try to get eight hours.
· Regular exercise.
· Diet – no alcohol or caffeine and reduce sugar, starches and carbohydrates from the diet.
· Stress reduction and relaxation techniques.
· Get counseling and support. For a busy working woman, this may mean a housekeeper.
· Nutritional supplements can include Evening Primrose Oil, vitamin B6, magnesium, calcium, tryptophan to help sleep and vitamin E.
· Bioidentical progesterone has been found useful.
· Drugs like Prozac are considered the first line of treatment in the western medical world. In some people the contraceptive pill can be useful, as well as diuretics, hormone controlling drugs and pain killers.