Premenstrual syndrome (PMS) comprises a range of emotional, physical, and behavioral symptoms that women experience monthly during the luteal phase of the menstrual cycle, typically ceasing with the onset of menstrual bleeding. This condition predominantly affects women of reproductive age with regular menstrual cycles.
For some women, the symptoms associated with premenstrual syndrome can be sufficiently impactful to restrict their daily functioning, encompassing family, professional, social, and physical activities, thus posing a substantial societal challenge.
Premenstrual syndrome
, as the name suggests, occurs before the onset of menstruation. Often, there are no signs or symptoms, but they can be so troublesome that they can eliminate a woman from normal functioning for a long time.
When PMS appears, it depends on the phase of the menstrual cycle. A woman's body undergoes cyclical changes that depend on the concentration of sex hormones produced by the ovary.
In the first phase, under the influence of estrogens, the follicle grows in the ovary, from which an egg is released approximately halfway through the cycle. During this time, the lining of the uterus begins to get thicker.
In the second phase (the so-called luteal), the uterus produces nutrients for the fertilized egg under the influence of another hormone, progesterone. If fertilization does not occur, the uterine lining sheds and menstrual bleeding occurs.
How far before your period can PMS manifest itself? A woman may experience the first symptoms after ovulation, and they become more severe until the fifth day before menstruation. More precisely, PMS symptoms occur during the luteal and menstrual phases.
Premenstrual tension is a highly individualized condition influenced by various factors. Typically, initial symptoms of PMS manifest between the ages of 25 and 35. The onset and intensity of these symptoms are unpredictable every month. However, the duration of premenstrual tension can be ascertained. Generally, symptoms subside either after menstruation or during its course.
The etiology of premenstrual syndrome remains incompletely elucidated, with predominant indications pointing to hormonal factors. Recent research suggests that progesterone metabolites, exerting their effects on the central nervous system, may underlie the manifestation of premenstrual syndrome.
It is theorized that an insufficiency of gestagens in conjunction with an abundance of estrogens could influence the onset of premenstrual tension symptoms. Notably, the abrupt cessation of PMS symptoms coincides with the onset of menstruation.
The duration and severity of PMS vary, with the condition predominantly affecting women over 30 and reaching peak severity in the years preceding menopause. Symptoms may be most pronounced after the age of 40. Following menopause, symptoms of premenstrual syndrome typically cease entirely. However, persisting symptoms post-menopause warrant comprehensive evaluation and diagnosis by a specialist, as they may be indicative of an alternative somatic or mental disorder.
Premenstrual syndrome is characterized by the co-occurrence of mental and physical symptoms.
Those include:
Women may experience:
The spectrum of symptom severity is different and individual for each woman. Very severe symptoms may even lead to suicide attempts.
Many of the above symptoms, such as breast soreness and tenderness, may indicate both premenstrual syndrome and pregnancy. Distinguishing them can often be extremely difficult, especially if a woman is impatiently waiting for the moment of getting pregnant. So, how can we differentiate between these two phenomena?
The best way is to wait until your expected period. If it appears, it is a sign that fertilization probably did not occur. If not, it is worth doing a pregnancy test. However, remember that if we perform the test too early, even the most sensitive test may give us a false result. This is related to many factors, including the woman's hormonal conditions, as well as the potential development of a biochemical pregnancy, i.e., miscarriage at a very early stage.
It is also worth noting that the symptoms of premenstrual syndrome mentioned above do not apply to women who are already at an advanced stage of pregnancy, pre-pubertal girls, or post-menopausal women.
In each case of severe symptoms before menstruation, which ends in the first days of bleeding, you should visit a gynecologist who will individually select appropriate diagnostic and treatment procedures.
A woman presenting symptoms indicative of premenstrual syndrome should seek consultation with a gynecologist. In addition to a comprehensive interview and potential blood pressure assessment, the specialist will conduct an initial gynecological examination, often involving a speculum. Furthermore, during diagnostic process the gynecologist may prescribe supplementary tests to rule out other conditions, such as:
In some instances, a psychiatric evaluation may be warranted, as specific mental health disorders (e.g., anorexia, bulimia, or depression) can manifest symptoms akin to those experienced in premenstrual syndrome.
Following the exclusion of other potential illnesses, the physician and patient will collaborate to determine the most appropriate course of action, primarily focusing on addressing the management of PMS.
If the symptoms are not bothersome, the treatment of premenstrual syndrome is mainly based on non-pharmacological methods.
You need to change your lifestyle, including:
When these methods are not effective, pharmacological agents are used to treat premenstrual syndrome, mainly analgesics and anti-tension medications. The use of new oral contraceptives also turns out to be effective.
The following medications contain estrogen and progesterone, which prevent water retention in the body. It is recommended to take one tablet daily at approximately the same time. Alternative approaches to managing premenstrual syndrome (PMS) include the use of patches or implants containing estrogens, which can reduce the severity of PMS symptoms. Estrogen promotes the growth of the uterine mucosa (endometrium), necessitating the simultaneous administration of progesterone to prevent uncontrolled endometrial growth. Progesterone can be administered through an intrauterine device (IUD) or orally in a cyclical manner for 10-12 days.
In cases where the treatments above prove ineffective, the last resort is the surgical removal of the uterus and its appendages (ovaries and fallopian tubes), resulting in the complete cessation of the menstrual cycle. It is important to note that a deficiency of sex hormones may lead to unfavorable consequences, and surgical intervention is reserved for severe cases of premenstrual syndrome.
In case of severe physical symptoms (headache, stomachache, and backache), the use of painkillers may alleviate PMS symptoms. Those drugs are recommended: non-steroidal anti-inflammatory drugs and antispasmodic drugs.
When premenstrual syndrome is troublesome, you can also use the so-called selective serotonin reuptake inhibitors (SSRIs). This is a group of antidepressants, so they should be taken under the supervision of a doctor. These drugs, by increasing the amount of serotonin, reduce tension and irritability, eliminate mood disorders, and reduce physical ailments.
They should be taken in the morning; it does not matter whether before or after eating. There are two treatment methods: one involves taking them daily, and the second involves taking medications from the middle of the menstrual cycle until the onset of menstruation – then there is a break of about two weeks.
Additionally, research is ongoing into using vitamins and other chemicals that may alleviate premenstrual syndrome.
A proper diet improves well-being and reduces the symptoms of premenstrual syndrome during PMS, which is already confirmed by general medicine. A PMS diet should be easily digestible (due to flatulence that occurs during PMS) and rich in unsaturated fatty acids, provide essential amino acids, vitamins, and minerals, and also make you feel full for a few hours to prevent constant snacking, which may affect weight gain.
Substances with potent anti-inflammatory properties help alleviate the symptoms of premenstrual syndrome. Many people also struggle with deficiencies, which may affect the severity of PMS-related symptoms.
Premenstrual syndrome is usually treated symptomatically, except for situations in which PMS symptoms are associated with the existence of specific diseases, such as gynecological diseases. Then it is necessary also to implement treatment for the underlying disease.
You can relieve mild symptoms of premenstrual tension on your own, including lifestyle changes, proper sleep hygiene, regular physical activity, and relaxation exercises. One of the first steps that should be taken is to introduce changes to the daily menu, namely:
It is worth remembering that in the case of painful cramps in the lower abdomen, we can also use painkillers and antispasmodics, which are available in pharmacies without a prescription. As already mentioned, to combat the severe psychosomatic symptoms of PMS, your doctor may recommend therapy with SSRIs (selective serotonin reuptake inhibitors), which treat mood disorders. These preparations are administered only in the luteal phase. Sometimes, to alleviate the symptoms of PMS in a patient, the doctor decides to prescribe oral contraceptives that are intended to inhibit ovulation and regulate hormone levels.
Women must recognize the significant role that lifestyle modifications play in managing symptoms and treating premenstrual syndrome (PMS). For women who smoke, limiting or ceasing smoking is particularly vital in PMS treatment due to the presence of over four thousand chemicals in tobacco smoke, each of which has adverse effects on the body.
In the prevention of PMS, emphasis should be placed on physical activity. Even gentle physical activity can yield noticeable effects after the initial attempt. Engaging in physical exercise stimulates the production of endorphins, which contribute to an improved sense of well-being. It is not necessary to engage in extensive gym workouts; longer walks or brief runs can serve as a starting point.
Yoga, a popular form of relaxation and exercise, can be practiced at home and offers another avenue for PMS prevention. The relaxation and stress-relief aspects of yoga make it an effective method for averting PMS.
Above all, women should heed their body's signals. Common PMS symptoms such as fatigue, drowsiness, and irritability can be mitigated through adequate rest. Additionally, maintaining a proper diet is paramount.
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