Premenstrual syndrome (PMS) is characterized by a group of somatic, behavioral, cognitive, and mood symptoms that appears 1 to 10 days before menses and usually subsides with its onset. Its effects range from minimal discomfort to severe, disruptive symptoms and can include anxiety, irritability, depression, and multiple somatic complaints.
Reportedly, 70% to 90% of women experience PMS sometime during their childbearing years, usually between ages 25 and 45.
The exact cause of PMS is not fully understood. It is thought to be linked to the changes in hormone levels that happen throughout your menstrual cycle. It is possible that women with low levels of the brain chemical serotonin are particularly sensitive to levels of the hormone progesterone, and this might lead to the symptoms of PMS.
Signs and Symptoms
The patient's history may include behavioral changes, ranging from mild to severe personality changes, nervousness, hostility, irritability, agitation, sleep disturbances, fatigue, lethargy, and depression. The patient may also report breast tenderness or swelling, abdominal tenderness or bloating, joint pain, headache, edema, diarrhea or constipation, and exacerbations of skin, respiratory, or neurologic problems.
A daily symptom calendar (in which the patient records menstrual symptoms and body temperature for two to three menstrual cycles) is the single most useful tool in diagnosing PMS.
Blood studies may be used to rule out anemia, thyroid disease, or other hormonal imbalances.
A psychological evaluation may be used to rule out or detect an underlying psychiatric disorder.
Education and reassurance that PMS is a real, physiologic syndrome are vital parts of treatment. The goal of treatment is to relieve the patient's symptoms. Initial interventions may focus on lifestyle changes, such as eating a diet low in simple sugars, caffeine, and salt; increasing calcium intake; increasing aerobic exercise; reducing stress; and practicing relaxation techniques.
Treatment may include antidepressants; vitamins, such as B complex; progestins; prostaglandin inhibitors; and nonsteroidal anti-inflammatory drugs.
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