Premenstrual syndrome (PMS) is a
symptom or collection of symptoms that occurs regularly in relation to
the menstrual cycle, with the onset of symptoms 5 to 11 days before the
onset of menses and resolution of symptoms with menses or shortly
thereafter.
An exact cause of PMS has not
been identified; however, it may be related to social, cultural,
biological, and psychological factors. PMS can occur with apparently
normal ovarian function (regular ovulatory cycles).
PMS is estimated to affect 70 to
90% of women during their childbearing years. Thirty to 40% of women are
thought to have PMS symptoms severe enough to interfere with daily
living activities, and 10% are believed to have symptoms so severe they
are considered disabling. The incidence is higher in women between their
late 20s and 40s years old, those with at least one child, those with a
family history of a major depression disorder, or women with a past
medical history of either post-partem depression or an affective mood
disorder.
As they approach menstruation,
about three-quarters of all women report some symptoms related to
fluctuating hormone levels. For about half, these symptoms are mild and
do not affect normal daily life; the other half report more severe
symptoms, including depression. Some experts diagnose PMS by having
women rate 17 PMS symptoms on a score of 0 (no symptoms) to four (very
severe). Women are defined as having PMS if they have a premenstrual
symptom score of at least 70 that is also 50% greater than the symptom
score rated after menstruation. Women with a diagnosis of PMS must also
have an impaired ability to function before a period. Only 3% to 5% of
women actually meet these stringent criteria, although far more report
having PMS. Premenstrual syndrome is not discussed in this report.
Self-care methods include
exercise and dietary measures mentioned previously under the
"Prevention" category. It is also important to maintain a
daily diary or log to record the type, severity , and duration of
symptoms. A "symptom diary" should be kept for a minimum of 3
months in order to correlate symptoms with the menstrual cycle. The
diary will greatly assist the health care provider not only in the
accurate diagnosis of PMS, but also with the proposed treatment methods.
Nutritional supplements may be
recommended. Vitamin B6 , calcium, and magnesium are commonly used.
Prostaglandin inhibitors
(aspirin, ibuprofen, other NSAIDS) may be prescribed for women with
significant pain, including headache, backache, menstrual cramping and
breast tenderness. Diuretics may be prescribed for women found to have
significant weight gain due to fluid retention.
Psychiatric medications and or
therapy may be used for women who exhibit a moderate-to-severe degree of
anxiety, irritability, or depression.Hormonal therapy may include a
trial on oral contraceptives which may either decrease or increase PMS
symptoms. The use of progesterone vaginal suppositories during the
second half of the menstrual cycle is still controversial.
After adequate diagnosis and
symptom-specific treatment has been initiated, most women with PMS
obtain significant relief.
