Definition

Premenstrual syndrome (PMS) refers to a compilation of over 150 symptoms that occur between ovulation and the onset of menstruation. The symptoms include both physical symptoms, such as breast tenderness, back pain, abdominal cramps, headache, and changes in appetite; behavioral symptoms such as clumsiness, poor concentration, and sleep problems; as well as psychological symptoms of anxiety, irritability, depression, and unrest. Severe forms of this syndrome are referred to as premenstrual dysphoric disorder (PMDD). These symptoms may be related to hormonal imbalances and emotional disorders.

Description

Between 40-75% of all menstruating women experience symptoms that occur before or during menstruation. PMS encompasses a wide range of symptoms, some as minor as appetite change or others so severe that they may interfere with daily life. Some women experience a beneficial increase in their sexual libido. Only 3-7% of women experience the much more severe premenstrual dysphoric disorder (PMDD). These symptoms can last 4-10 days and can have a substantial impact on a woman.

The reason some women get severe PMS while others have little or none is not understood. PMS symptoms usually begin at puberty and last until menopause. Women more sensitive to hormonal change may experience PMS more than others. Stress is also a huge contributor and the relief of tension often lessens the other symptoms as well. Overall however, it is difficult to predict who is most at risk for PMS.

Causes & symptoms

Because PMS is restricted to the second half of a woman's menstrual cycle, after ovulation, it is thought that hormones play a role. During a woman's monthly menstrual cycle, which lasts from 24-35 days, hormone levels change. The hormone estrogen gradually rises during the first half of a woman's cycle, the pre-ovulatory phase, and falls dramatically at ovulation. After ovulation, the post-ovulatory phase, progesterone levels gradually increase until menstruation occurs. Both estrogen and progesterone are secreted by the ovaries, which are responsible for producing the eggs. The main role of these hormones is to cause thickening of the lining of the uterus (endometrium). However, estrogen and progesterone also affect other parts of the body, including the brain. In the brain and nervous system, estrogen can affect the levels of neurotransmitters, such as serotonin. Serotonin has long been known to have an effect on emotions, as well as eating behavior. It is thought that when estrogen levels go down during the post-ovulatory phase of the menstrual cycle, decreases in serotonin levels follow. Whether these changes in estrogen, progesterone, and serotonin are responsible for the emotional aspects of PMS is not known with certainty. However, most researchers agree that the chemical transmission of signals in the brain and nervous system is in some way related to PMS. This is supported by the fact that the times following childbirth and menopause are also associated with both depression and low estrogen levels.

Nutritional deficiencies, food allergies, and hypoglycemia have been linked with PMS. A diet deficient in essential fatty acids , zinc, magnesium, and vitamin B₆ may affect estrogen and progesterone production and their balance in the body.

Over 150 symptoms for PMS have been identified. These include physical, behavioral, and emotional aspects that range from mild to severe. The physical symptoms include bloating, headaches, food cravings, abdominal cramps, headaches, tension, fatigue, acne, muscle aches, and breast tenderness. Behavioral symptoms may include insomnia, lack of concentration, and clumsiness. Emotional aspects include mood swings, irritability, and depression.

Diagnosis

The best way to diagnose PMS is to review a detailed diary of a woman's symptoms for several months. PMS is diagnosed by the presence of physical, psychological, and behavioral symptoms that are cyclic and occur in association with the premenstrual period of time. PMDD, which is far less common, was officially recognized as a disease in 1987. Its diagnosis depends on the presence of at least five symptoms related to mood that disappear within a few days of menstruation. These symptoms must interfere with normal functions and activities of the individual.

Treatment

There are many treatments for PMS and PMDD depending on the symptoms and their severity. Hypnotherapy, spiritual healing, color therapy , reflexology, Ayurvedic medicine , Chinese herbalism, acupuncture, acupressure, aromatherapy, herbal treatment, Naturopathic treatment, and homeopathy are all therapies that have been used to treat PMS.

Vitamins and minerals

Some women find relief with the use of vitamin and mineral supplements. Magnesium can reduce the fluid retention that causes bloating, while calcium may decrease both irritability and bloating. Magnesium and calcium also help relax smooth muscles, which may reduce cramping. Recent studies indicate that calcium supplements can reduce premenstrual complaints by nearly half. Vitamin E reduces breast tenderness, nervous tension, fatigue, and insomnia. Vitamin B₆ decreases fluid retention, fatigue, irritability, and mood swings. Vitamin B₅ supports the adrenal glands and may help reduce fatigue.

Phytoestrogens and natural progesterone

The Mexican wild yam , Dioscorea villosa, contains a substance that may be converted to progesterone in the body. Because this substance is readily absorbed through the skin, it can be found as an ingredient in many skin creams. (Some products also have natural progesterone added to them.) Some herbalists believe that these products can have a progesterone-like effect on the body and decrease some of the symptoms of PMS.

The most important way to alter hormone levels may be by eating more phytoestrogens. These plant-derived compounds have an effect similar to estrogen in the body. One of the richest sources of phytoestrogens is soy products, such as tofu. Additionally, many supplements can be found that contain black cohosh (Cimicifuga racemosa) or dong quai (Angelica sinensis), which are herbs high in phytoestrogens. Red clover (Trifolium pratense), alfalfa (Medicago sativa), licorice (Glycyrrhiza glabra), hops (Humulus lupulus), and legumes are also high in phytoestrogens. Increasing the consumption of phytoestrogens is also associated with decreased risks of osteoporosis, cancer, and heart disease .

Herbal treatment

Herbal treatment has been used to treat many symptoms of PMS. Herbs to alleviate cramps include angelica root, cramp bark , kava kava , red raspberry, black haw , and rosemary. Black cohosh, peppermint, strawberry leaf, and valerian root have been used to decrease mood swings. Dandelion, couch grass, and hawthorn are effective diuretic herbs used to reduce bloating and swelling. Burdock root and red clover are liver cleansing herbs that can be useful in eliminating excess estrogen from the system. Herbs to balance hormones include blessed thistle , dong quai, false unicorn root, fennel seed, sarsparilla root, and squaw vine. Feverfew may be effective for migraine headaches.