Author's details
Reviewer's details
Premenstrual Syndrome
Premenstrual syndrome (PMS) is a syndrome consisting of both physical and psychological disturbances occurring a few days before the monthly menstrual period and ending 2-3 days after the blood flow. It is a constellation of several signs and symptoms. PMS can also be defined as a cyclical, luteal-phase condition characterized by physical, psychological, and or behavioural changes of sufficient severity to interfere with normal activity. It is a common occurrence in women of the reproductive age group with varying degrees of severity and unpredictability. Most women can navigate through this period without requiring specialized hospital care. Premenstrual dysphoric disorder (PMDD) is considered a more severe and disabling form of PMS. PMDD is listed as a mental health disorder in the DSM-5 while PMS is not. . PMDD causes significant disability and affects day-to-day activities. It requires medical and psychological interventions.
The signs and symptoms of premenstrual syndrome can be broadly classified into 2; the physical symptoms and the emotional/psychological symptoms.
Physical symptoms include; joint and/or muscle pains, fatigue, headache, fluid retention giving a false weight gain, breast tenderness, acne break-outs, abdominal bloating, constipation or diarrhea, and alcohol intolerance.
Psychological/emotional symptoms include; depressed mood, crying spells, tension/anxiety, irritability, sleep disturbances, poor concentration, change in libido, social isolation, sugar cravings, and change in appetite.
Clinical findings are consistent with cyclical physical and emotional disturbances occurring a few days before the menstrual flow and stopping in less than 4 days after blood flow. The severity of the symptoms and how they affect day-to-day activities will help in diagnosing either premenstrual syndrome or premenstrual dysphoric disorder.
1. Serotonin deficiency: women with PMS have decreased serotonin level.
2. Hormonal shift: Patients with PMS have been shown to have exaggerated response to normal hormonal changes, giving rise more pronounce emotional and physical responses.
3. Deficiencies of minerals like calcium and magnesium.
4. Obesity: women with BMI of atleast 30 are three times to develop PMS that those Who are not obsese.
5. Smoking is a significant risk factor for PMS.
6. Adverse early childhood experiences in a form of abuse (physical, sexual or emotional) predict the risk for PMS in middle or late reproductive years.
Depression, anxiety, Dysmenorrhea, chronic fatigue syndrome, menstrual migraine, cyclic mastalgia, thyroid disease, febrile illnesses like malaria, enteric fever, early pregnancy, threatened abortion, and premenstrual dysphoric disorder.
Premenstrual syndrome is diagnosed clinically after ruling out the possible differential diagnoses. There is no specific laboratory investigation that is used to make a diagnosis. To establish a premenstrual pattern, the client is required to keep a record of when the symptoms start, the day of her menstrual cycle, and occurring consecutively for at least 2 months.
Treatment depends on the severity of symptoms and primarily pharmacologic and behavioural, with an emphasis on relief of symptoms Some medications that can be used include; antidepressants, especially selective serotonin reuptake inhibitors (SSRI) like sertraline, paroxetine and fluoxetine. They help in improving mood symptoms associated with PMS. Other medications include; diuretics, analgesics (NSAIDs) and hormonal contraceptives.
Behavioural interventions that have been found useful include; CBT, Exercise, Yoga, Relaxation response, Massage, Biofeedback, Guided imagery etc.
No routine follow-up required.
Symptoms of premenstrual syndrome can be reduced by avoiding excessive sugar intake and stress, get adequate sleep and drink lots of water.
Premenstrual syndrome is a common condition among women of child bearing age, it is mostly harmless and most women get better with age.
A 28-year-old female from a rural community presents with irritability, mood swings, bloating, and breast tenderness occurring one week before her menstrual period for over a year. Symptoms subside after menstruation begins, negatively impacting her daily life and work.
Diagnosis: Premenstrual Syndrome (PMS).
Management Plan:
1. Lifestyle Modifications: Increased physical activity and a balanced diet to reduce symptoms.
2. Psychosocial Support: Counseling and education to address emotional symptoms and reduce stigma.
3. Pharmacological Treatment: Over-the-counter pain relief, with possible referral for antidepressive medications.
Challenges: Limited healthcare access and cultural misconceptions about menstruation. Follow-up recommended for symptoms monitoring and support.
1. Modern Management of Perinatal Psychiatric Disorders (Second edition) Henshaw Carol Cox John Barton Joanne Modern Management of Perinatal Psychiatric Disorders (Second edition)
2. Shorter Oxford Textbook of Psychiatry Paul Harrison, 6th edition
3. Review of psychiatry Praveen Tripathi, 7th edition
4. Kaplan and Sadock’s comprehensive textbook of Psychiatry 9th edition
5. African textbook of psychiatry by Professor David Musyimi Ndetei
6. Maharaj S, Trevino K. A comprehensive Review of Treatment options for Premenstrual Syndrome and Premenstrual Dysphoric Disorder. J Psychiatr Pract. 2015; 21(5): 334-350
7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing;2013.
Author's details
Reviewer's details
Premenstrual Syndrome
Premenstrual syndrome (PMS) is a syndrome consisting of both physical and psychological disturbances occurring a few days before the monthly menstrual period and ending 2-3 days after the blood flow. It is a constellation of several signs and symptoms. PMS can also be defined as a cyclical, luteal-phase condition characterized by physical, psychological, and or behavioural changes of sufficient severity to interfere with normal activity. It is a common occurrence in women of the reproductive age group with varying degrees of severity and unpredictability. Most women can navigate through this period without requiring specialized hospital care. Premenstrual dysphoric disorder (PMDD) is considered a more severe and disabling form of PMS. PMDD is listed as a mental health disorder in the DSM-5 while PMS is not. . PMDD causes significant disability and affects day-to-day activities. It requires medical and psychological interventions.
1. Modern Management of Perinatal Psychiatric Disorders (Second edition) Henshaw Carol Cox John Barton Joanne Modern Management of Perinatal Psychiatric Disorders (Second edition)
2. Shorter Oxford Textbook of Psychiatry Paul Harrison, 6th edition
3. Review of psychiatry Praveen Tripathi, 7th edition
4. Kaplan and Sadock’s comprehensive textbook of Psychiatry 9th edition
5. African textbook of psychiatry by Professor David Musyimi Ndetei
6. Maharaj S, Trevino K. A comprehensive Review of Treatment options for Premenstrual Syndrome and Premenstrual Dysphoric Disorder. J Psychiatr Pract. 2015; 21(5): 334-350
7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing;2013.
Content
Author's details
Reviewer's details
Premenstrual Syndrome
Background
Premenstrual syndrome (PMS) is a syndrome consisting of both physical and psychological disturbances occurring a few days before the monthly menstrual period and ending 2-3 days after the blood flow. It is a constellation of several signs and symptoms. PMS can also be defined as a cyclical, luteal-phase condition characterized by physical, psychological, and or behavioural changes of sufficient severity to interfere with normal activity. It is a common occurrence in women of the reproductive age group with varying degrees of severity and unpredictability. Most women can navigate through this period without requiring specialized hospital care. Premenstrual dysphoric disorder (PMDD) is considered a more severe and disabling form of PMS. PMDD is listed as a mental health disorder in the DSM-5 while PMS is not. . PMDD causes significant disability and affects day-to-day activities. It requires medical and psychological interventions.
Further readings
1. Modern Management of Perinatal Psychiatric Disorders (Second edition) Henshaw Carol Cox John Barton Joanne Modern Management of Perinatal Psychiatric Disorders (Second edition)
2. Shorter Oxford Textbook of Psychiatry Paul Harrison, 6th edition
3. Review of psychiatry Praveen Tripathi, 7th edition
4. Kaplan and Sadock’s comprehensive textbook of Psychiatry 9th edition
5. African textbook of psychiatry by Professor David Musyimi Ndetei
6. Maharaj S, Trevino K. A comprehensive Review of Treatment options for Premenstrual Syndrome and Premenstrual Dysphoric Disorder. J Psychiatr Pract. 2015; 21(5): 334-350
7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing;2013.
Advertisement