Premenstrual Syndrome (PMS). All You Need to Know.

Food cravings, irritability, bloating, acne and you know that she is  around the corner! As if having monthly periods isn’t enough, women have to deal with a barrage of symptoms know as the Premenstrual syndrome. These can become frustrating, not knowing why they happen, and not knowing how to make them stop. Well, let’s get some answers. 

Understanding Premenstrual Syndrome (PMS). 

PMS are group of symptoms that occur in women, typically between ovulation and a period. This condition can affect a woman’s emotions, physical health, and behavior during certain days of the menstrual cycle, generally just before her menses.

PMS is a very common condition. Studies show that 90 percent of menstruating women show symptoms. A diagnosis is made when it affects or impairs some aspect of life.  For some women, these symptoms may be so severe that they miss work or school, but other women are not bothered by milder symptoms. On average, women in their 30s are most likely to have PMS. 

Is PMS normal? 

The first thing we must understand is that PMS is completely normal. It is basically your body responding to hormonal changes and these changes can vary from person to person and this explains the wide range of symptoms experienced. 

The symptoms of PMS are usually mild or moderate. Nearly 80 percent of women report one or more symptom that does not substantially affect daily functioning, according to the journal American Family Physician. 20-32% of women report moderate to severe symptoms that affect some aspect of life. 3-8%  report premenstrual dysphoric disorder  PMDD. The severity of symptoms can vary by individual and by month.

Why Does PMS Occur?

To understand PMS, we need a general understanding of the menstrual cycle. A woman’s menstrual cycle lasts an average of 28-35 days. Ovulation, the period when an egg is released from the ovaries, occurs on day 14 of the cycle. Menstruation, occurs on day 28 of the cycle. PMS symptoms can begin around day 14 and last until seven days after the start of menstruation. (Note that these dates are averages and can vary from person to person). 

PMS symptoms start 5 to 11 days before menstruation and typically go away once menstruation begins. The cause of PMS is unknown. However, many researchers believe that it’s related to a change in both sex hormoneand serotonin levels at the beginning of the menstrual cycle. 

Levels of estrogen and progesterone increase during certain times of the month. An increase in these hormones can cause mood swings, anxiety, and irritability. Ovarian steroidsalso modulate activity in parts of your brain associated with premenstrual symptoms. Serotonin levels affect mood. Serotonin is a chemical in your brain and gut that affects your moods, emotions, and thoughts.

An interplay of these hormones are simply responsible for the symptoms experienced. 

What are the symptoms of PMS? 

PMS is a syndrome and as such it combines a vast ranges of possible symptoms. Mostly, one will experience one or more of the commons symptoms listed below. 

Physical symptoms of PMS can include:

• Swollen or tender breasts
• Constipation or diarrhea
• Bloating or a gassy feeling
• Cramping or abdominal pain
• Headache or backache
• Acne
• Clumsiness
• Lower tolerance for noise or light

Emotional or mental symptoms of PMS include:

• Irritability or hostile behavior
• Feeling tired
• Sleep problems (sleeping too much or too little)
• Appetite changes or food cravings
• Trouble with concentration or memory
• Tension or anxiety
• Depression, feelings of sadness, or crying spells
• Mood swings
• Less interest in sex
• Emotional outbursts
• Sensitivity to light or sound

Are there risk factors for PMS? 

Like any other condition, some individuals are more predisposed to PMS than others. Don’t be mad if some ladies have it easier during their periods while you struggle with certain symptoms.

• a history of depression or mood disorders, such as postpartum depression or bipolar disorder
• a family history of PMS
• a family history of depression
• domestic violence
• substance abuse
• physical trauma
• emotional trauma

Also some associated conditions lead to more episodes of PMS. They include:

• dysmenorrhea
• major depressive disorder
• seasonal affective disorder
• generalized anxiety disorder
• schizophrenia

How do I know I have PMS? 

It’s should be noted that not every symptom within your period is PMS and some food cravings might just be food cravings (Don’t give up on your fitfam goals). 

There is no single test for PMS. Your doctor will discuss with you about your symptoms, including when they happen, how often, and how much they affect your life. A diagnosis is usually made based on the following criteria: 

• If it happens five days before your period for at least three menstrual cycles in a row. 
• If it ends within four days after your period starts
• If it keep you from enjoying or doing some of your normal activities

To aid your Doctor in making a diagnosis; 

Keep track of which PMS symptoms you have and how severe they are for a few months. Write down your symptoms each day on a calendar or with an app on your phone. Take this information with you when you see your doctor.

When to see your Doctor? 

See your doctor if physical pain, mood swings, and other symptoms beginning to significantly affect your daily life, or if your symptoms don’t go away.

How can relieve symptoms of PMS at home? 

Understanding that PMS is normal can help allay some fears usually experienced and help one to adopt better coping mechanisms and means to treat them even at home. These tips will help you be healthier in general, and an relieve some of your PMS symptoms.

• Get regular aerobic physical activity throughout the month. Exercise can help with symptoms such as depression, difficulty concentrating, and fatigue.
• Choose healthy foods most of the time. Avoiding foods and drinks with caffeine, salt, and sugar in the two weeks before your period may lessen many PMS symptoms. 
• Get enough sleep. Try to get about eight hours of sleep each night. Lack of sleep is linked to depression and anxiety and can make PMS symptoms such as moodiness worse.
• Find healthy ways to cope with stress. Talk to your friends or write in a journal. Some women also find yoga, massage, or meditation. 
• Don’t smoke. In a study women who smoked reported more PMS symptoms and worse PMS symptoms than women who did not smoke.
• Drinking plenty of fluids to ease abdominal bloating
• Taking supplements, such as folic acid, vitamin B-6, calcium, and magnesium to reduce cramps and mood swings. 

What medications can treat PMS? 

Medications and supplements should only be taken as directed by and after speaking with your doctor. Pain medication, such as ibuprofen or aspirin, can be taken to alleviate muscle aches, headaches, and stomach cramping. Diuretics can help  to stop bloating and water weight gain. Hormonal birth control pills, antidepressants have also been used. 

Premenstrual dysphoric disorder (PMDD)

This is a severe form of PMS. It’s a rare condition as only a small percentage of women who have severe symptoms have premenstrual dysphoric disorder (PMDD). PMDD affects between 3 and 8 percent of women.

The symptoms of PMDD may include:

• depression
• thoughts of suicide
• panic attacks
• extreme anxiety
• anger with severe mood swings
• crying spells
• a lack of interest in daily activities
• insomnia
• trouble thinking or focusing
• binge eating
• painful cramping
• bloating

The symptoms of PMDD may occur due to changes in your estrogen and progesterone levels. A connection between low serotonin levels and PMDD also exists.

It’s important to monitor your symptoms of PMS in order to identify when a condition of PMS has now become PMDD. Your doctors will take a detailed history, do a physical exam and runs some investigations before making a diagnosis. Treatment usually involves pharmacotherapy and psychotherapy.

Long-term outlook

PMS and PMDD symptoms can recur, but they typically go away after the start of menstruation. A healthy lifestyle and a comprehensive treatment plan can reduce or eliminate the symptoms for most women.

REFERENCE 

• PREMENSTRUAL SYNDROME (PMS). Health line.Medically reviewed by Chris Kapp, M.D. — Written by Valencia Higuera Updated on May 11, 2019
• Premenstrual syndrome. Women’s health. https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome#13
• Pinkerton, J.V., Guico-Pabia, C.J., Taylor, H.S. (2010). Menstrual cycle-related exacerbation of disease. American Journal of Obstetrics and Gynecology; 202(3): 221-231.
• American College of Obstetricians and Gynecologists. (2015). Premenstrual Syndrome (PMS) (link is external)
• El-Lithy, A., El-Mazny, A., Sabbour, A., El-Deeb, A. (2014). Effect of aerobic exercise on premenstrual symptoms, haemotological and hormonal parameters in young women. Journal of Obstetrics and Gynaecology; 3: 1–4.
• Aganoff, J. A., Boyle, G. J. (1994). Aerobic exercise, mood states and menstrual cycle symptoms. Journal of Psychosomatic Research; 38: 183–92.
• What to know about PMS. Medically reviewed by Deborah Weatherspoon, Ph.D., R.N., CRNA — Written by Jamie Eske on May 29, 2019