Premenstrual syndrome (PMS) is a condition of women at the beginning and end of their reproductive years. The highest incidence is found among women in their 20s with another peak for women in their 40s. Other experts say it is most common in women 30-45 years of age. It is rare in early adolescence, though some parents notice cyclic irritability in their prepubescent daughters.
PMS is usually worsened with oral hormonal contraceptive use. Stress can be a factor as well. However, PMS is lessened in women who have had a hysterectomy with both ovaries removed and placed on continuous estrogen therapy.
A deficiency in the neurotransmitters serotonin and endorphins has been noted with women who have PMS. This might be the end result than the cause, since estrogen levels determine the level of circulating tryptophan, a serotonin precursor. A deficiency in serotonin can make a person irritable or depressed. A relative progesterone deficiency could also be another possibility, however, as above, estrogen could be the real cause.
Many women complain of fluid retention or bloating. However, it is probably better to state that is more of a redistribution of fluid since there is little if any weight gain. Since symptoms respond to supplementation of vitamin B6, B complex, and Vitamin A, deficiency of these vitamins has been theorized. The most likely cause, however, is steroid imbalance resulting in a deficiency of serotonin and endorpbins.
Symptoms connected with PMS are legion. At least 150 have been associated with this disorder making diagnosis and assessment of PMS and the response to various medications difficult. The most common symptoms are irritability, depression, headaches (including migraines), breast tenderness, bloating and cramping.
The most important factor in diagnosing PMS is that the symptoms must be most pronounced in the luteal phase of the cycle and at least a symptom free period of at least 7 days in the pre-ovulatory phase. Women who are charting their cycles may note a shortening of the luteal phase. These symptoms must occur for at least 3 consecutive cycles.
Assessing as whether the various treatments for PMS work is difficult since there is a marked response to placebo. There have been only a few studies that have been blinded to the treatment.
Mild symptoms of PMS can be treated with reassurance. Knowledge that the woman client is not "crazy" may help her gain a sense of control. NFP charting can help her to predict when these symptoms will occur.
A proper diet with small frequent feedings of complex carbohydrates and a decrease intake of simple (processed) sugars can help. The woman client should be advised to avoid alcohol since it may lower inhibitions and worsen outbursts. Alcohol also has a depressant effect. Traditionally, women have been told to avoid caffeine, but that advice is controversial. Recent studies have not confirmed this.
Regular exercise, 20 minutes per day at least 3 times per week, has been suggested. This recommendation is arbitrary, but makes good overall health sense. Avoidance of elected stress during the luteal phase is suggested, if possible. Relaxation techniques such as meditation may help.
For over the counter medications, 1000 mg of calcium a day has been shown in studies to be effective. This is the equivalent of 2 "Tums" per day. The full effect will not be noticed for about 3 months. If the woman is unable to get at least 15 minutes of sunshine a day, then Vitamin D should also be taken as a supplement. Primrose oil was shown in an uncontrolled study to decrease depression, edema, and breast tenderness, Vitamins B6, B complex and A are useful as well. Non-steroidal anti-inflamatories such as ibuprofen are sold over the counter and can be helpful for headaches and other generalized symptoms.