Premenstrual Syndrome (PMS) encompasses a vast array of psychological symptoms such as depression, anxiety, irritability, loss of confidence and mood swings. There are also physical symptoms, typically bloatedness and breast pain. It is the timing, rather than the types of symptoms, and the degree of impact on a woman’s daily activity that supports a diagnosis of PMS.
Four in ten women (40%) experience symptoms of PMS and of these 5% – 8% suffer from severe PMS. Although the cause remains uncertain, it is assumed that some women are ‘sensitive’ to progesterone and progestogens. The second theory implicates the neurotransmitters serotonin and c-aminobutyric acid (GABA), in causing PMS symptoms. Reducing salt, caffeine, and stress along with increasing exercise is typically all that is recommended in those with mild symptoms. Calcium and vitamin D supplementation may be useful in some. Anti-inflammatory drugs may help with physical symptoms. In those with more severe symptoms, birth control pills may be useful.
How is PMS diagnosed?
When clinically reviewing women for PMS, symptoms should be recorded prospectively, over two cycles using a symptom diary.
How is PMS managed?
Referral to a gynecologist should be considered when the severity of symptoms increases. Unsaturated fatty acids, as contained in evening primrose oil, should be considered. Other measures like multivitamins, magnesium, calcium, Vitamin-D, isoflavones, can also be tried.
Drospirenone-containing oral contraceptives used for 3 months can reduce the severity of symptoms. SSRIs(Selective Serotonin Reuptake Inhibitors) should be considered one of the first-line pharmaceutical management options in severe cases of PMS.
When treating women with PMS, hysterectomy and bilateral oophorectomy can be considered when medical management has failed, or other gynaecological conditions indicate surgery.
Specialist Gynaecologist
Aster Clinic, Dubai Silicon Oasis
