Premenstrual syndrome

Overview

Premenstrual syndrome (PMS) refers to a group of physical, emotional, and behavioral symptoms that occur in the luteal phase of the menstrual cycle—typically one to two weeks before menstruation begins—and resolve shortly after menstruation starts. PMS affects millions of menstruating individuals, with up to 75% of women reporting some premenstrual symptoms during their reproductive years. For some, PMS symptoms are mild, while others experience significant disruption to their daily lives. A more severe form of PMS is known as premenstrual dysphoric disorder (PMDD), which involves intense mood disturbances and requires specific treatment.

Causes

The exact cause of PMS is not fully understood, but it is believed to result from the interaction between fluctuating hormone levels and neurotransmitters in the brain. Several factors may contribute to its development:

• Hormonal fluctuations: Changes in estrogen and progesterone levels during the menstrual cycle are believed to influence mood and physical symptoms

• Serotonin levels: Altered serotonin (a brain chemical that regulates mood) may play a key role in PMS-related depression and irritability

• Genetics: A family history of PMS or mood disorders increases susceptibility

• Stress: High levels of stress can worsen PMS symptoms

• Poor diet and lack of exercise: May contribute to fatigue, mood swings, and other symptoms

• Underlying mental health conditions: Such as depression or anxiety, can exacerbate PMS symptoms

Symptoms

PMS symptoms typically begin after ovulation (mid-cycle) and subside once menstruation begins. They vary in type and severity between individuals and from cycle to cycle. Common symptoms include:

Emotional and Behavioral Symptoms

• Mood swings

• Irritability or anger

• Anxiety or tension

• Crying spells or increased sensitivity

• Depressed mood

• Difficulty concentrating

• Changes in sleep patterns (insomnia or hypersomnia)

• Appetite changes or food cravings

• Social withdrawal

Physical Symptoms

• Breast tenderness or swelling

• Abdominal bloating

• Headaches or migraines

• Joint or muscle pain

• Fatigue or low energy

• Weight gain due to fluid retention

• Acne flare-ups

• Constipation or diarrhea

Diagnosis

There is no specific test to diagnose PMS. Diagnosis is based on a pattern of symptoms that occur consistently in relation to the menstrual cycle. The following steps are typically involved:

• Symptom tracking: Keeping a daily record of symptoms and their timing in relation to the menstrual cycle over 2–3 months is essential for diagnosis

• Exclusion of other conditions: Conditions such as depression, anxiety disorders, thyroid disease, and chronic fatigue syndrome may mimic or exacerbate PMS and must be ruled out

• Clinical criteria: Diagnosis is made when physical and emotional symptoms interfere with daily functioning and consistently appear during the luteal phase of the cycle

Treatment

Treatment of PMS depends on the severity of symptoms and their impact on daily life. A combination of lifestyle changes, dietary adjustments, medications, and therapy may be recommended.

Lifestyle and Home Remedies

• Exercise: Regular aerobic exercise improves mood and reduces fatigue

• Dietary changes: Reducing salt, caffeine, sugar, and alcohol can alleviate symptoms; increasing intake of calcium, magnesium, and complex carbohydrates may help

• Sleep hygiene: Maintaining a regular sleep schedule and ensuring restful sleep

• Stress reduction: Techniques like yoga, meditation, and deep breathing exercises

Medications

• Over-the-counter pain relievers: Such as ibuprofen or naproxen for cramps, headaches, and joint pain

• Oral contraceptives: Hormonal birth control can stabilize hormone fluctuations

• SSRIs (Selective Serotonin Reuptake Inhibitors): Such as fluoxetine or sertraline, used to treat mood symptoms and PMDD

• Diuretics: For managing bloating and fluid retention

• GnRH agonists: Used in severe cases to suppress ovarian function (reserved for refractory cases)

Supplements

• Calcium (1000–1200 mg/day)

• Vitamin B6

• Magnesium

• Chasteberry extract (Vitex agnus-castus)

Prognosis

The prognosis for premenstrual syndrome is generally favorable, especially with appropriate lifestyle changes and treatment. Most individuals find that symptoms improve with a combination of dietary changes, stress management, and, when necessary, medications. PMS tends to persist throughout the reproductive years but may improve with age or resolve completely after menopause. For those with severe symptoms or PMDD, long-term treatment and support may be necessary to maintain quality of life. Early recognition and management are key to reducing the impact of PMS on daily functioning and emotional well-being.