Premenstrual syndrome (PMS) is a common health problem among woman in their reproductive age. PMS is listed in the International Statistical classification of Diseases & related health problems 10 th revision (ICD-10) under disorders of genitourinary system. It is a very distressing disorder occurring around the menstrual cycle of a female having implications in the quality of life of a woman.
The symptoms included are anxiety, depression, irritability, tearfulness, anger, loss of interest in work and somatic symptoms like bloating, mastalgia i.e., breast pain, headache. Generally, these symptoms start appearing 6 days before the onset of menses and peaks at 2 days prior to beginning of the menstrual flow. This symptomatology may persist for few days to 2 weeks once it begins.There occurs symptom free interval between the cyclicity of the symptoms.
The set of psychological and somatic symptoms are similar in each menstrual cycle and thus one of the most important criteria for the diagnosis of PMS.
PMS is known to affect a woman’s life in every way. It not only affects the personal health, but also the relationship to others, sexual life, social activities and work productivity. The temperamental issues are many, and it could also lead to irregularity by increasing absenteeism from school, college and office. Women tend to become irritable, have mood swings, and often complain of physical discomfort too. Not many are able to understand or cooperate with them, and they are left to handle this on their own, with no support from anywhere. This again is a jinx, as it is a normal and monthly process, and women are conditioned to accept and be uncomplaining about it.
The risk factors predisposing a woman susceptible to PMS are:
One or more of these is also associated with increasing one’s susceptibility to PMS.
There occur various grades of PMS and includes mild, moderate and severe forms and premenstrual dysphoric disorders (PMDD). PMDD is defined under Diagnostic and Statistical Manual of mental disorders. Moderate to severe PMS have an incidence of 5-8% worldwide. In a study among a group of college students in Gujarat, India, the prevalence of moderate-severe PMS was found to be 14.7% and 3.7% for PMDD. Most commonly reported symptoms in this study were fatigue or lack of energy in 68.3%, decreased interest in work in 60.1% and anger or irritability in 59.9% students.
The symptoms in Premenstrual Syndrome may be associated with increased responsiveness of a woman to normal fluctuating levels of hormones in body and these are estrogen and progesterone on central nervous system and other affected organ systems. Other hormones implicated in the etiology of PMS are thyroid hormone, melatonin, cortisol and relaxing. The hypothalamic-pituitary-adrenal axis is known to act sub-optimal in women with PMS. Serotonin, one of the neurotransmitters in the human body is also deemed responsible for the symptoms. Decreased levels of serotonin are known to be associated with increased carbohydrate craving, poor impulse control and mood irritability.
If you or your dear ones are suffering from such symptoms, you should visit your gynecologist who can also involve a psychiatrist or psychologist for the best treatment of yours.
Your doctor will investigate you completely to rule out associated comorbidities like major mental disorders,personality disorders or medical conditions. There exist various psychologist tools like premenstrual symptom screening tools including a set a questionnaire that will help your doctor to reach a correct diagnosis. Daily charting of symptoms is required over two menstrual cycles for confirmatory diagnosis to be made. There exist no laboratory tests for the same. Conditions like anemia or thyroid disorders may be present associated with PMS/PMDD. There can be diseases with aggravation premenstrual like seizures and should be differentiated from PMS/PMDD.
Management of PMS/PMDD is based on use of drugs acting to inhibit the hypothalamic pituitary ovarian axis in order to curtail the hormonal changes. Drugs acting on CNS may also be prescribed.First line agent is SSRI (selective serotonin reuptake inhibitors). But try not to self-treat yourself.There are non-pharmacological treatment options as well. This includes lifestyle changes, having balanced diet low in fat and salt, regular exercises, healthy sleep-wake cycle and cessation of smoking and alcohol intake. Including vitamin B6, vitamin E, calcium and vitamin D supplementation may also help. Use of drugs to decrease pain like mefenamic acid can be useful in many women.Other modes of therapy like music therapy, cognitive behavioral therapy, stress reduction and anger management therapy may be employed and have to be individualized. However, one should be convinced that there is no one treatment regimen that can help in relieving all the symptoms of PMS/PMDD. Treating doctor may call you every two weeks in the beginning of initiation of treatment to assess your response to treatment with you asked to continue daily charting of symptoms.
So, to conclude majority women suffer from premenstrual symptoms but minority are diagnosed as PMS/PMDD who require treatment to help them combat with the difficulties she suffers. The family and friends can not be under emphasized to help the woman along with pharmacological and non-pharmacological therapy.
1) Raval, Madhusudan C, Navinchandra B et al. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder among college students of Bhavnagar, Gujarat. Indian Journal of Psychiatry. 2016; 58(2): 164-170.
Dr. Kanika Chopra (MBBS, MS Obstetrics and Gynecology) is working as an Assistant Professor in Lady Hardinge Medical College, New DELHI. She has also worked as an Associate consultant in Sir Ganga Ram Hospital, New Delhi in the minimally invasive surgery unit. A dynamic and diligent doctor, she was awarded the BEST POST-GRADUATE AWARD in her residency period and has received many prizes for her work. An avid writer and researcher, she has authored over 30 articles in both National and International Journals, and wellness magazines.
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