PREMENSTRUAL SYNDROME (PMS)

What is it? PMS is a group of emotional and physical changes prior to menstruation. They can appear in some women up to 10 days prior to menstruation and end either at the onset of or during their period. The medical term for these changes is "premenstrual syndrome," commonly called PMS. More than 150 symptoms are associated with PMS, ranging from breast tenderness to nausea to anger and irritability. Premenstrual changes occur in nearly 80% of menstruating women. The symptoms vary from woman to woman and from cycle to cycle. Their intensity ranges from mild to incapacitating. About 20% to 40% of women who have PMS experience symptoms that make life difficult and 2.5% to 5% experience PMS that is debilitating. What causes it? The cause of PMS is unknown, but scientists continue to study it. Some feel PMS results from hormonal changes. It is likely the symptoms are related to a combination of chemical or dietary deficiencies and physiological, genetic, nutritional, and behavioral factors. There is no diagnostic test for PMS. Tests may be used to rule out other conditions in women who experience severe symptoms. Emotional and physical changes that are in sync with a womans menstrual cycle are usually a telltale sign. What are the symptoms? Symptoms may vary from woman to woman and can be categorized into the following common symptoms: Mood-related ("affective") symptoms: depression, sadness, anxiety, anger, irritability, frequent and severe mood swings Mental process ("cognitive") symptoms: decreased concentration, indecision Pain: headache, breast tenderness, joint and muscle pain Nervous system symptoms: insomnia (sleeplessness), hypersomnia (sleeping for abnormally long periods of time), anorexia, food cravings, fatigue, lethargy, agitation, a change in sex drive, clumsiness, dizziness or vertigo, prickling or tingling sensation Gastrointestinal symptoms: nausea, diarrhea, palpitations (rapid fluttering of the heart), sweating Fluid and electrolyte symptoms: bloating, weight gain, reduced urination Skin symptoms: acne, oily skin, greasy or dry hair

How does it get diagnosed if theres no test for it? It is difficult to diagnose because theres no clear cause and the symptoms vary and are found in other disorders. The cyclical pattern is crucial for a diagnosis: symptoms appear prior to menstruation and resolve when bleeding begins. A medical history and physical examination involve an evaluation of the symptoms and when they occur in relation to menstruation. Many clinicians advise women to keep a diary of menstrual cycles and the physical and psychological changes they experience over several months. The menstrual diary provides clues to the provider and helps women understand and cope with the changes. Thyroid function tests and other tests that evaluate the production of hormones are used to rule out other medical disorders. Tests may be done to rule out menstrual-related pain occurring just before and during menstruation and endometriosis. Because depression is a common feature of PMS, some women undergo psychological counseling as part of the diagnostic procedure. Psychologists, who are professionally trained to recognize depression and other mood disorders, may be able to differentiate the cyclical pattern of depression associated with PMS from the psychiatric disorder. How is it treated? Treatment focuses on relieving symptoms and involves exercise, dietary changes, stress reduction and medication.

Exercise
Exercise has a big effect on hormones, including those involved in the menstrual cycle. Women who exercise experience less anger and depression. Exercise also reduces stress, which makes PMS symptoms worse. Women who experience PMS, are encouraged to exercise regularly, 20-45 minutes, 3 times a week.

Nutrition
It is not clear how dietary changes affect PMS. Some studies show drinking tea and increasing carbohydrates during the

weeks preceding menstruation is helpful. Carbohydrates increase the level of serotonin (low levels of serotonin have been linked to PMS-related depression). Some nutritionists recommend vitamins, especially vitamin B6. Reducing or eliminating alcohol, caffeine, refined sugar, salt, dairy products, and animal fats may also help. A professional nutritionist or dietician can advise you on dietary changes that may relieve symptoms.

Stress reduction
Stress reduction can help reduce PMS symptoms. Physical trainers and physical therapists can help women incorporate exercise and movement into their lives. A counselor or therapist can provide advice on reducing stress as well.

Medication
When exercise, diet, and other lifestyle changes have not helped, medication may be effective.
[Some source material from the Womens Health Channel]

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