Premenstrual syndrome (PMS): Causes, Risk factors, Symptoms, Treatment and Prevention

Premenstrual Syndrome Definition

Premenstrual syndrome is a menstrual disorder that involves physical and emotional symptoms occurring one to two weeks before menstruation during the luteal phase of the menstrual cycle. Most women experience PMS, with symptoms typically ending when menstruation starts.

Premenstrual Syndrome (PMS) meaning

• The term "menstrual" originated from the old French word "menstruel," which is derived from the Latin word "menstrualis" It refers to monthly cycles, related to females.

• The Latin root "menstruus" means monthly occurrences and is linked to the word "mensis," which means "month." 

Days back in 1865, the meaning of premenstrual was before menstrual. In 1928, it was referred to as premenstrual tension syndrome; the term premenstrual syndrome (PMS) emerged in 1971. 

Prevalence of Premenstrual Syndrome

The prevalence of reproductive-age women affected with PMS worldwide amounts to 47.8%. Among these, 20% of women experience severe symptoms which disrupt their daily activities, and the others have mild to moderate symptoms.

Prevalence of Premenstrual Syndrome in India

As per some studies in India, a wide range of prevalence estimates for premenstrual syndrome (PMS) has been reported, ranging from 14.3% to 74.4%. 

Premenstrual Syndrome Causes

The causes of premenstrual syndrome (PMS) are not fully understood because premenstrual symptoms co-occur with the hormonal changes of the menstrual cycle. The following are some of the causes of premenstrual syndrome which include:

• Hormonal changes: Hormonal changes like excess oestrogen, progesterone deficiency and fluctuation of oestrogen levels during the luteal phase are responsible for mood changes leading to premenstrual syndrome.
• Chemical changes in the brain: Serotonin is a neurotransmitter and an etiological factor that regulates mood. Symptoms of PMS are linked to serotonin levels. The substances the body uses to produce serotonin are known as Serotonin precursors, and they increase significantly between 7 to 11 days and 17 to 19 days of the menstrual cycle causing PMS. 
• Hence, PMS is closely related to mood disorders through the regulation of oestrogen-serotonin levels. 
• Progesterone interaction: It is believed that the interaction of progesterone with neurotransmitters is influenced by PMS. Preexisting serotonin deficiency combined with high levels of progesterone plays a role in the development of PMS. 
• Prolactin levels: High prolactin levels are linked with low levels of oestrogen, which may cause symptoms such as depression. The association of High prolactin levels with low levels of progesterone may cause symptoms such as anxiety or irritability. 
• Glucose metabolism alterations and insulin resistance: Lower blood glucose levels and insulin resistance were found after ovulation or during the luteal phases of the menstrual cycle. Hence, hypoglycaemia is a stimulating factor of PMS symptoms .
• Abnormal hypothalamic–pituitary–adrenal (HPA) axis function: The HPA axis controls various physiological processes and stress responses, including the production of hormones. HPA axis abnormalities are a factor linked to premenstrual syndrome (PMS), particularly the hormonal fluctuations that occur during the menstrual cycle. 

Risk factors of Premenstrual Syndrome

Risk factors of PMS are essential to help individuals and healthcare providers identify those who are more susceptible to experience severe symptoms. Here are some common risk factors:

 

• Being obese: Women with a higher BMI have a greater chance of developing severe PMS compared to women with normal BMI. A possible reason for the relationship between PMS and BMI is the lower level of oestradiol in women with higher body weight. 
• Age: Premenstrual syndrome (PMS) commonly affects women of childbearing age, and symptoms often begin in the late 20s to early 30s. 
• Stress: Experiencing high levels of stress can trigger symptoms of premenstrual syndrome (PMS) and disrupt the delicate hormone balance in the body, potentially contributing to the onset of PMS. 
• Sedentary lifestyle: A sedentary lifestyle or low physical activity levels can contribute to hormonal imbalances, including disruptions in oestrogen and progesterone levels. These fluctuations play a significant role in the onset and severity of PMS symptoms. 
• Improper diet: Dietary choices, such as consuming high amounts of caffeine, sugar, or alcohol, can exacerbate PMS symptoms. A diet lacking vitamins and minerals, especially calcium and magnesium, can also increase the risk of PMS. 
• Smoking: Smoking impacts on hormonal balance and circulation. It increases the risk and severity of PMS symptoms. 
• Mental health: Individuals experiencing severe PMS symptoms may also have conditions such as depression, anxiety, and other mental health disorders, as fluctuations in hormones, particularly progesterone, can affect neurotransmitters such as serotonin, which play a role in regulating mood. 
• Family history: Women with a family history of PMS or mood disorders are more likely to experience symptoms indicating a potential genetic component. 
  

Premenstrual Syndrome Symptoms

Premenstrual syndrome (PMS) symptoms include both emotional and physical symptoms that can impact the quality of life. It's important to remember that symptoms usually stop during or at the beginning of the menstrual period. This means there is at least one symptom-free week before symptoms start returning, and the premenstrual syndrome symptoms include:

PMS Physical symptoms

• Breast tenderness or swelling
• Abdominal bloating 
• Acne
• Diarrhoea and constipation
• Fluid retention
• Weight gain

PMS Emotional symptoms

• Irritability
• Anxiety
• Low mood
• Trouble with concentration and memory
  

Complications Of Premenstrual Syndrome

Complications of premenstrual syndrome affect women’s daily life and overall well-being. Some of these complications include:

• Relationship problems: Untreated PMS can affect sexual life, which can lead to sexual distress and relationship problems.
• Psychological issues: PMS can cause mood swings, irritability, anxiety, and depression, which can lead to psychological issues. 
• Absenteeism in the workplace: Poor menstrual hygiene management can results in feelings of shame, anxiety, and embarrassment that contribute to absenteeism and poor performance.
  

Premenstrual Syndrome Diagnosis 

There is no single method for diagnosing premenstrual syndrome. A gynaecologist confirms it based on three key elements:

• The symptoms must match those of PMS.
• The symptoms must occur only during the luteal phase of the menstrual cycle.
• The symptoms must negatively impact the patient's daily function and lifestyle.

Once a physician is suspicious of the diagnosis, patients are advised to keep a diary of premenstrual symptoms that includes. 

• Calendar of premenstrual experiences (COPE): Among other things, it is the most valid and reliable tool for diagnosing PMS. However, these methods require immense time and effort since patients must report their symptoms daily for at least two menstrual cycles.
• Daily record of severity of problems (DRSP)

Laboratory diagnostic testing is not necessary, but it can be used as a complementary tool. For example:

• Blood count: This blood count can be recommended to check for anaemia.
• Thyroid function tests: These tests can help detect hypothyroidism and hyperthyroidism. 
  

Premenstrual Syndrome Treatments

The main intention of PMS treatment is to relieve symptoms and reduce its effects on daily routine activities. Recent research has suggested that there are superior benefits of combination therapies they include:

• Pharmacological management
• Selective serotonin reuptake inhibitors
• Combined oral contraceptives
• Gonadotropin-releasing hormone
• Diuretics

• Nonpharmacological management
• Cognitive-behavioural therapy
• Complementary therapies
• Dietary supplements
  

Pharmacological Management

The pharmacological approach of treating premenstrual syndrome includes drugs as mentioned below:

• Selective serotonin reuptake inhibitors: SSRIs can be used as the first-line therapy. These are preferred due to their rapid onset of effect. They can be administered continuously or cyclically during the luteal phase to alleviate symptoms effectively. 
• Combined oral contraceptives: COCs are less effective in treating the affective symptoms of PMS compared with SSRIs. 
• Gonadotropin-releasing hormone: GnRH agonists rarely treat severe PMS. These medications interfere with the balance of hormones in the body, significantly reducing the production of hormones in the ovaries. 
• Diuretics: Diuretics, also called water pills, may reduce symptoms of bloating and breast tenderness.
  

Nonpharmacological Management

Nonpharmacological has been proven beneficial for treating premenstrual symptoms. Hence, here are some of the therapies that include: 

• Cognitive-behavioural therapy: CBT focuses on correcting disruptive thoughts, behaviours, and emotions. 
• Complementary therapies: Complementary therapies may help with PMS, but there's not much evidence that they work. Some of the therapies include:
• Acupuncture
• Reflexology

• Dietary supplements: Dietary supplements may help with PMS, but there's not much evidence. The following are some of the supplements that can be helpful in reducing the symptom of PMS, such as 
• Vitamin B6
• Calcium
• Vitamin D 
• Magnesium 

Premenstrual Syndrome Prevention

Prevention of PMS (Premenstrual Syndrome) focuses on reducing the symptoms and improving the quality of life. Here are some strategies that can help to prevent PMS symptoms:

• Exercising regularly: Daily physical activity can help balance hormone levels and improve mood, potentially reducing some PMS symptoms
• Maintaining a healthy diet: Maintaining a healthy, balanced diet and eating small meals every two to three hours can help manage weight. 
• Managing stress: It's important to get enough sleep and manage stress through activities like yoga to reduce symptoms. 
• Taking painkillers: When needed, taking painkillers (prescribed by healthcare professional) can help in managing cramps during PMS.
• Tracking PMS symptoms: Keeping a symptom diary for at least two menstrual cycles can help to track the changes that occur throughout the menstrual cycle and to identify any abnormalities. 
• Avoiding excessive consumption of alcohol: Avoiding the consumption of alcohol and caffeine for at least two weeks before periods can help in managing symptoms. 
  

Difference between PMS and Pregnancy symptoms

PMS symptoms vs Pregnancy symptoms

Premenstrual syndrome (PMS) and pregnancy symptoms can have many similarities, but some symptoms are more likely to indicate pregnancy:

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