What is PMS?

Premenstrual syndrome (PMS) (also called PMT or premenstrual tension) is a collection of physical and emotional symptoms related to a woman's menstrual cycle. While most women of child-bearing age (up to 85%) report having experienced physical symptoms related to normal ovulatory function, such as bloating or breast tenderness, medical definitions of PMS are limited to a consistent pattern of emotional and physical symptoms occurring only during the luteal phase of the menstrual cycle that are of "sufficient severity to interfere with some aspects of life". In particular, emotional symptoms must be present consistently to diagnose PMS. The specific emotional and physical symptoms attributable to PMS vary from woman to woman, but each individual woman's pattern of symptoms is predictable, occurs consistently during the ten days prior to menses, and vanishes either shortly before or shortly after the start of menstrual flow. Only a small percentage of women (2 to 5%) have significant premenstrual symptoms that are separate from the normal discomfort associated with menstruation in healthy women.

Culturally, the abbreviation PMS is widely understood in English-speaking countries to refer to difficulties associated with menses, and the abbreviation is used frequently even in casual and colloquial settings, without regard to medical rigor. In these contexts, the syndrome is rarely referred to without abbreviation, and the connotations of the reference are frequently more broad than the clinical definition.

Premenstrual dysphoric disorder (PMDD) is a more severe condition, positioned as a psychiatric disorder similar to unipolar depression.

Causes

The exact causes of PMS are not fully understood. While PMS is linked to the luteal phase, measurements of sex hormone levels are within normal levels. In twin studies, the concordance of PMS is twice as high in monozygotic twins as in dizygotic twins, suggesting the possibility of some genetic component. Current thinking suspects that central-nervous-system neurotransmitter interactions with sex hormones are affected. It is thought to be linked to activity of serotonin (a neurotransmitter) in the brain.

Preliminary studies suggest that up to 40% of women with symptoms of PMS have a significant decline in their circulating serum levels of beta-endorphin. Beta endorphin is a naturally occurring opioid neurotransmitter which has an affinity for the same receptor that is accessed by heroin and other opiates. Some researchers have noted similarities in symptom presentation between PMS symptoms and opiate withdrawal symptoms.

In one study of 71 women with PMS ,elevated levels of serum pseudocholinesterase were found. This enzyme is considered a possible marker for trait-anxiety.

A variety of evolutionary rationales for the syndrome have been offered, including that it is an epiphenomenon due to the selective advantage accruing to other phases of the hormonal cycle, that it leads to "intensification of male ardour during the next onset of fertility", and that it prompts females to reject infertile males (who cause PMS due to not impregnating the female). "an infertile male/potentially fertile female partnership would tend to break down, thus allowing a new pair-bond to be formed. The greater the degree of premenstrual hostility of the female, the sooner a fertile mating could ensue." Any theory would have to account for the persistence of PMS over substantial evolutionary time, as it appears to afflict baboons as well.

Symptoms

More than 200 different symptoms have been associated with PMS, but the three most prominent symptoms are irritability, tension, and dysphoria (unhappiness). Common emotional and non-specific symptoms include stress, anxiety, difficulty in falling asleep (insomnia), headache, fatigue, mood swings, increased emotional sensitivity, and changes in libido. Formal definitions absolutely require the presence of emotional symptoms as the chief complaint; the presence of exclusively physical symptoms associated with the menstrual cycle, such as bloating, abdominal cramps, constipation, swelling or tenderness in the breasts, cyclic acne, and joint or muscle pain.

The exact symptoms and their intensity vary from woman to woman and even from cycle to cycle. Most women with premenstrual syndrome experience only a few of the possible symptoms, in a relatively predictable pattern. Under typical definitions, symptoms must be present at some point during the ten days immediately before the onset of menses, and must not be present for at least one week between the onset of menses and ovulation. Although the intensity of symptoms may vary somewhat, most definitions require that the woman's unique constellation of symptoms be present in multiple, consecutive cycles.

Western Medicine Treatment

Many treatments have been suggested for PMS, including diet or lifestyle changes, and other supportive means. Medical interventions are primarily concerned with hormonal intervention and use of selective serotonin reuptake inhibitors (SSRIs).

Supportive therapy includes evaluation, reassurance, and informational counseling, and is an important part of therapy in an attempt to help the patient regain control over her life. In addition, aerobic exercise has been found in some studies to be helpful. Some PMS symptoms may be relieved by leading a healthy lifestyle: Reduction of caffeine, sugar, and sodium intake and increase of fiber, and adequate rest and sleep.

Dietary intervention studies indicate that calcium supplementation (1200 mg/d) may be useful. Also vitamin E (400 IU/d) has shown some effectiveness. A number of other treatments have been suggested, although research on these treatments is inconclusive so far: Vitamin B6, magnesium, manganese and tryptophan.

SSRIs can be used to treat severe PMS. Women with PMS may be able to take medication only on the days when symptoms are expected to occur, Although intermittent therapy might be more acceptable to some women, this might be less effective than continuous regimens.

Hormonal intervention may take many forms:

Hormonal contraception is commonly used; common forms include the combined oral contraceptive pill and the contraceptive patch. This class of medication may cause PMS-related symptoms in some women, and may reduce physical symptoms in other women. They do not relieve emotional symptoms.

Progesterone support has been used for many years but evidence of its efficacy is inadequate.

Gonadotropin-releasing hormone agonists can be useful in severe forms of PMS but have their own set of significant potential side effects.

Diuretics have been used to handle water retention. Spironolactone has been shown in some studies to be useful.

Non-steroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen) have been used to treat pain.

Evening primrose oil, which contains gamma-Linolenic acid (GLA), has been advocated but lacks scientific support. Clonidine has been reported to successfully treat a significant number of women whose PMS symptoms coincide with a steep decline in serum beta-endorphin on a monthly basis.

Chasteberry has been used by women for thousands of years to ease symptoms related to menstrual problems. It is believed some of the compounds found within Chasteberry work on the pituitary gland to balance hormone levels.

DL phenylalanine can reduce or prevent symptoms of PMS in some women. It is only effective when the PMS is associated with an abrupt decline in circulating serum beta-endorphin levels.

Recent evidence suggests that daily treatment with St. Johns wort (Hypericum perforatum) may improve the most common physical and emotional symptoms associated with PMS.

Adopted from wikipedia.com