Understanding Premenstrual Syndrome: Symptoms & Management

Premenstrual Syndrome (PMS) is a condition characterized by distressing physical, behavioral, and psychological symptoms that occur in the absence of organic disease. These symptoms regularly manifest during the luteal phase, which is the premenstrual period, and typically resolve by the end of menstruation.

PMS affects girls from adolescence through to menopause. It is estimated that 85% of women experience some form of PMS, with 5% suffering from severe PMS. Based on severity, PMS can range from mild to moderate to severe. Severe PMS can significantly interfere with personal, social, and professional life, often leading to social withdrawal. Premenstrual Dysphoric Disorder (PMDD) represents a severe form of PMS.

The exact cause of PMS remains largely unknown. Possible contributing factors include genetic predispositions and cultural influences. Notably, approximately 40% of affected individuals experience a significant decline in beta-endorphins.

Symptoms of PMS:

Physical symptoms include breast tenderness, bloating, weight gain or fluid retention, headaches, acne, constipation or diarrhea, and abdominal pain. Psychological symptoms encompass fatigue, trouble sleeping, irritability, anxiety, low mood, depression, and decreased concentration or memory.

Diagnosis and Differential Diagnosis:

PMS is diagnosed by a gynecologist. The diagnostic criteria include the presence of symptoms for five days before a period, with symptom resolution after menstruation ends. These symptoms should be present for two consecutive menstrual cycles. The severity of PMS is assessed by the degree to which it interferes with normal activities. Differential diagnoses to consider include depression, anxiety, perimenopause, chronic fatigue syndrome, and irritable bowel syndrome.

Management of PMS:

Management strategies for PMS involve a multifaceted approach. Lifestyle changes, such as regular exercise, a healthy diet, and sufficient sleep, are recommended. Dietary modifications include a diet rich in complex carbohydrates, calcium-rich foods like yogurt and green leafy vegetables, and a decreased intake of fat, salt, and sugar. Avoiding caffeine and alcohol is also advised.

Pharmacological interventions include supplementation with calcium, vitamin D, magnesium (which helps reduce bloating), vitamin B6, omega-3 and omega-6 fatty acids, and evening primrose oil. Severe PMS and PMDD are often treated with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Cycle suppression can be achieved with oral contraceptive pills, transdermal estradiol patches, and progesterone intrauterine devices. Diuretics may provide relief from fluid retention.

Stress management techniques, such as cognitive behavioral therapy (CBT), relaxation exercises, yoga, meditation, counseling, and support from family and friends, are also beneficial.

PMS is frequently underestimated, yet it significantly impacts the quality of life for many women. A multidisciplinary team, including a gynecologist, nutritionist, psychiatrist, and counselor, should be involved in the comprehensive management of PMS. Keeping a diary of symptoms for at least two to three months can help identify which treatments are most beneficial for an individual.

(The writer is a Consultant - Gynaecology & Obstetrics, Manipal Hospital, Vijayawada)