PMS
Premenstrual Syndrome - An Overview
Premenstrual syndrome (PMS) is the name given to the physical, psychological and behavioural symptoms that can occur in the two weeks before a woman's monthly period. It is also known as premenstrual tension (PMT).
There are many different symptoms of PMS, but typical examples are: • Bloating; • Breast pain; • Mood swings; • Feeling irritable; • Loss of interest in sex
These symptoms usually improve when the sufferer’s period starts and disappear a few days afterwards. Nearly all women of childbearing age have some premenstrual symptoms, but women in their late 20s to their early 40s are most likely to experience PMS.
Around 1 in every 20 women have symptoms that are severe enough to stop them living their normal lives. This is often the result of a more intense type of PMS known as premenstrual dysphoric disorder (PMDD).
Why it happens The exact cause of PMS isn't fully understood. However, it's thought to be linked to the changing levels of hormones in the body during a woman's menstrual cycle.
The fact that PMS improves during pregnancy and after the menopause, when hormone levels are stable, supports this theory.
Certain lifestyle factors are also thought to aggravate the symptoms of PMS, including: • Lack of exercise and being overweight;
• Stress; • A poor diet
Hormone changes During the menstrual cycle, levels of hormones such as oestrogen and progesterone rise and fall. Hormone changes are thought to be the biggest contributing factor to many of the symptoms of PMS.
It has also been suggested that changes in hormone levels during the menstrual cycle may affect the levels of certain chemicals in the brain, such as serotonin.
Serotonin is known to help regulate mood and improves happiness levels,
so a reduction in the level of serotonin caused by changes in hormone levels may explain the mood changes often associated with PMS. It may also explain why selective serotonin reuptake inhibitors (SSRIs) – helps some women with PMS.
Lifestyle factors There are also a number of lifestyle factors that can increase risks of PMS. These are outlined below.
Weight and exercise: Research has shown that women are more likely to have PMS if they are obese (body mass index of more than 30) and if they do little exercise.
Stress: Symptoms of PMS tend get worse, if the sufferer becomes stressed. While it's not a direct cause, stress can aggravate the symptoms of PMS.
Diet: Eating too much of some foods and too little of others may also contribute to PMS symptoms. For example, too much salty food may make some feel bloated.
Alcohol and caffeinated drinks can disrupt mood and energy levels. Low levels of vitamins and minerals may also make PMS symptoms worse.
Complementary treatments There are many non-prescribed alternative treatments and supplements that claim to help treat PMS. Some women may find these helpful for easing their symptoms. For example, supplements of calcium, vitamin D, magnesium and agnus castus (herb known as chasteberry) may reduce some symptoms of PMS.
Medical treatment If the PMS is severe, many women will seek medical treatment and advice or they may have Premenstrual Dysphoric Disorder (PMDD). However, there's no single treatment that works for everyone.
A wide range of treatments are available. Some women have to try several before finding one that suits. Choice of treatment will be based on
symptoms and how severe they are, and the possible side effects of the medication.
Medical treatments for PMS include: • Painkillers; • A combined oral contraceptive pill; • Oestrogen-only patches and implants;
• Selective serotonin reuptake inhibitors (SSRIs);
• Gonadotrophin-releasing hormone (GnRH) analogues
Painkillers Painkilling medication, including paracetamol and non-steroidal anti- inflammatory drugs (NSAIDs), can relieve some of the painful PMS symptoms such as: • Stomach cramps; • Headaches; • Muscle pain and joint pain
Oral contraceptive pills As well as preventing pregnancy, the combined contraceptive pill may help improve symptoms of PMS in some women by preventing ovulation In particular, newer types of contraceptive pill containing certain versions of the hormone progestogen, such as the Yasmin pill, have been shown to be effective for treating some PMS symptoms, and may even be effective for improving symptoms of PMDD.
However, contraceptive pills don't help all women and they can have side effects similar to the symptoms of PMS, such as breast pain or a depressed mood.
Oestrogen-only patches and implants Like combined contraceptive pills, oestrogen-only patches and implants may help improve some symptoms of PMS by preventing ovulation. However, they're usually only used to treat PMS under the guidance of a Gynaecologist.
Unless the patient has had a hysterectomy, oestrogen patches and implants also need to be combined with a low dose of the hormone progestogen. This is to reduce the risk of thickening of the womb lining
(endometrial hyperplasia), which can develop into womb cancer. This may be in the form of progestogen tablets or a progestogen-releasing intrauterine system (IUS).
Side effects of using an oestrogen patch can include skin irritation, itching and soreness, and the additional progestogen dose can have side effects similar to the symptoms of PMS.
Selective serotonin reuptake
inhibitors (SSRIs) Selective serotonin reuptake inhibitors (SSRIs) may be the most effective treatment for severe PMS or PMDD.
SSRIs, such as fluoxetine and sertraline, are antidepressants that can be taken daily to relieve tiredness, food cravings and sleep problems, and combat depression. However, SSRIs also may have negative side effects that could outweigh their benefits, such as: • Nausea; • Insomnia; • Headache; • Loss of libido
Gonadotrophin-releasing
hormone (GnRH) analogues Gonadotrophin-Releasing Hormone (GnRH) analogues are synthetic hormones that create a temporary menopause and stop periods by blocking the production of oestrogen and progesterone. They're taken as an injection. GnRH analogues should only be used in women with severe PMS when all other treatments have failed.
They often have side effects such as:
• Hot flushes; • Vaginal dryness; • Loss of libido; • Osteoporosis
They should only be taken alone for up to six months.
If GnRH analogues are used for longer than this, hormone replacement therapy (HRT) should be prescribed to reduce menopausal complications such as osteoporosis. n
References available upon request
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