Premenstrual Syndrome (PMS) is a combination of symptoms that begin with ovulation (mid cycle)and end somewhere between a day before menses and the onset of menstruation, or shortly thereafter. These symptoms can dramatically reduce the quality of life enjoyed by a woman, her co-workers, and her family.

The incidence of PMS is not affected by racial background, socioeconomic status, or marital status; it occurs in all classes and races, and is equal among married, separated, and divorced women.  It can also occur in women who have had a hysterectomy in which the ovaries were spared.      

Symptoms of PMS

PMS consists of a variety of psychological, neurological, vascular, and gastrointestinal symptoms. Here is a guide to some of these symptoms.

Psychological symptoms:

Mood swings, depression, lethargy, decreased self-esteem, confusion, insomnia, tension, overeating or craving for certain foods, decrease in productivity and efficiency at work and at home, and an increase in interpersonal conflicts. 

Neurological and vascular symptoms:

Headaches, dizziness, vertigo, swelling of the extremities, weight gain, and breast tenderness, among others.

Gastrointestinal symptoms:

Bloating, constipation, nausea, vomiting, and change in appetite.

Some other symptoms:

Some women experience a decreased resistance to infection, including an higher tendency to have recurrent yeast infection or genital herpes.  Still others suffer from allergy flare-ups, joint pain, lower back pain, and pelvic pain.

Symptoms vary from individual to individual and those women who report symptoms of PMS do not necessarily experience them with each cycle. Symptoms may also change as a woman grows older.

Some women experience only a mild type of premenstrual tension like exacerbation of headaches, migraines, convulsion, and itching. But up to 10% of women have a severe type of premenstrual tension, sometimes referred to as Premenstrual Dysphoric Disorder (PMDD).  In some cases, the symptoms can be so severe that their daily activities, work, and family life are greatly compromised.  Some women can become so depressed that they may contemplate suicide.

Causes of PMS

Because the symptoms of PMS are so numerous and no single causal factor has been identified, several cause have been proposed.       

One theory supposes that PMS occurs because of a deficiency of progesterone, since it is a cyclic 'disorder' associated with the second half of the menstrual cycle (the luteal phase). Others have said that it may be caused by an underlying endocrine dysfunction due to a diet high in salt and refined carbohydrates and low in vitamins and foods high in nutrition. A third cause put forward blames an excess of prostaglandin hormones for the symptoms of PMS A fourth theory cites an inadequate level of endorphins, the natural painkillers that are produced by the brain. (a lack of endorphins could potentially cause the brain's sensitivity to pain and other eural signals that affect moods to slip.)

According to a study done at Bailor College of Medicine, women with premenstrual syndrome may be suffering from a treatable mineral imbalance -a lack of Zinc. Zinc eficiency can alter a woman's mental and emotional state. 

Finally, the last school of thought says that all women respond differently to hormonal changes that occur within their menstrual cycles. PMS may be due to genetic factors that influence the way some women metabolize hormones.

Diagnosis of PMS

It is recommended that women with premenstrual tension jot down theirsymptoms for at least two menstrual cycles.  'Symptoms-charting' helps a woman to determine which symptoms are the most disturbing to her and on which days treatment is needed.  If the symptoms occur throughout the menstrual cycle, the diagnosis of PMS is unlikely. It is more probable that the woman has a depressive or anxiety disorder which is exacerbated premenstrually. Specific circumstances pertaining to a woman's life, such as previous pregnancies, the influence of the postpartum period, and any family history of mental illness, should also be noted, as they may diminish or exacerbate symptoms.

Women should also consider other important situations that could be causing PMS-type symptoms. These include endocrinological issues like diabetes or thyroid problems; pelvic diseases such as endometriosis or ovarian cysts; drug abuse, neurological or gastrointestinal diseases; and psychological problems.  For the patient who is experiencing serious depression and suicidal tendencies, an underlying depression exacerbated by PMS could be the bigger problem.

Treatment of PMS

Exercise - The majority of women feel better with a program of exercise.During exercise, the body releases endorphins that help reduce anxiety and tension. Exercise also improves circulation that, in turn, can decrease bloating and breast tenderness.

Nutrition - Good nutrition has been shown to improve the symptoms of PMS. It has been recommended that active people eat more than three meals (instead, six smaller meals a day).This is especially recommended for PMS sufferers with a tendency toward hypoglycemia (low blood sugar).It is also important to avoid stimulants like caffeine, refined }sugar (cakes, cookies and candies) fats, and alcohol. In addition, it may also be a good idea to cut down on salt intake.A diet high in calcium or taking some type of 1200 mg supplement, such as two Tum-Ex a day, has been shown to offer relief from PMS. Magnesium supplements can also ease PMS symptoms. In one study, women taking 400 mg of magnesium daily during PMS had less breast pain, weight gain, nervous tension and headaches. Women who take 50 mg of vitamin B6 daily can also reduce symptoms like bloating, swelling, irritability, lethargy, and breast tenderness.

Alternative Therapies - Alternative therapies that can be useful to women with PMS include Ayurvedic medicine, and herbal medicine.       

PMS and stress management techniques

Many women with PMS do very well when they learn stress management. It is normal for everyone to experience stress in their lives. But if the stress is not well managed, hormones are pumped into the bloodstream until they assault the blood vessels, the heart, the immune system and the liver. This produces such problems as high blood pressure, ulcers, headaches, chronic muscular tension, high cholesterol levels and heart attacks. In women it can also cause menstrual irregularities.

Coping with stress

Women sometimes need to learn to say no to another task and insteadtake time off for their own needs. But some women find it very difficult to learn to relax, especially if they have a busy lifestyle and small children.

Here's an easy way for the busy woman to replenish her energy supply.Find a place in the house and associate it in your mind with a place of self-renewal. Make this place a recharging zone! Inform the other household members that when you are in this place, you should NOT be disturbed. After a long day, take a warm shower or, even better, a warm bath. While playing with the water, think about something that brings you joy, like walking on the beach, feeling the wind blow on your face, and curling the soft, warm sand between your toes.

When we're stressed, we tend to take quick, shallow breaths. To reduce stress, take the opposite tack -- slow, deep breaths, inhaling deeply and holding the air for a few seconds, then releasing the air very gradually. The result can be excellent for your mind and your body.

Women who do not respond to conservative treatments may require additional medication. The treatment of PMS is to be modeled for each patient since not all patients present the same symptoms nor the same degree of severity.

Some women do well when placed on birth control pills or Depot Provera, which inhibits ovulation; like women during pregnancy, breastfeeding, and menopause, women that do not ovulate do not suffer from premenstrual tension.

Another approach is the use of Gonadotropin releasing hormone (GnRH)to eliminate the production of hormones. Since women on GnRH become menopausal, this treatment should be reserved for severe cases of PMS, especially those that do not response to antidepressants. This treatment is also very expensive.

Finally, it is important to keep in mind that the use of an antidepressant is necessary in some cases, especially in women with a severe depressive component.  Some may need to be assessed by a psychiatrist.