Premenstrual syndrome
Dr Wrishi Raphael
Miss Shayela, a 25 year old Human Resource Executive hailing from Mouchak Dhaka, presented to the office of her family physician, with the complaints of difficulty in sleeping, and irritability for the last few months. She has notice that these unpleasant symptoms tend to be repetitive and sometimes interfere with her daily schedule. On examination her vital signs are stable and systemic review did not reveal any abnormality. Careful and detailed history taking led to the diagnosis of premenstrual syndrome.
What is premenstrual syndrome?
It refers to physical and emotional symptoms that occur in the one to two weeks before a womans period. Symptoms often vary between women and resolve around the start of bleeding.
Premenstrual Syndrome may produce any of the following syndromes:
Difficulty sleeping
Tense feelings
Irritability
Clumsiness
Mood swings
Headache
Cravings for sweet foods
Cravings for salty foods
Cravings for other types of food
Depression
Angry feelings for no reason
Feelings that are easily upset
Poor concentration or memory
Feelings of low self-worth
Violent feelings
Weight gain
Abdominal bloating
Breast tenderness
Swelling of extremities
Dysmenorrhea (painful periods)
Change in bowel habits
Frequent urination
Hot flashes or cold sweats
General aches or pains
For some, the physical pain and emotional stress are severe enough to affect their daily lives. Regardless of symptom severity, the signs and symptoms generally disappear within four days of the start of the menstrual period for most women.
But a small number of women with premenstrual syndrome have disabling symptoms every month. This form of PMS is called premenstrual dysphoric disorder (PMDD).
PMDD signs and symptoms include depression, mood swings, anger, anxiety, feeling overwhelmed, difficulty concentrating, irritability and tension.
Exactly what causes premenstrual syndrome is unknown, but several factors may contribute to the condition:
Cyclic changes in hormones. Signs and symptoms of premenstrual syndrome change with hormonal fluctuations and disappear with pregnancy and menopause.
Chemical changes in the brain. Fluctuations of serotonin, a brain chemical (neurotransmitter) that is thought to play a crucial role in mood states, could trigger PMS symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems.
Depression. Some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms.
Treatment of premenstrual syndrome:
The benefits of exercise include physical improvements as well as stress reduction. Regular aerobic exercise has been shown to decrease symptoms in some adolescents and young women.
One study found that women with PMS typically consume more dairy products, refined sugar, and high-sodium foods than women without PMS. Accordingly, many clinicians recommend reducing or eliminating these foods from the diet.
Avoidance of salt, caffeine, alcohol, chocolate, or simple carbohydrates may alleviate symptoms. Medications helpful in PMS include Non Steroidal Anti Inflammatory Drugs, Anti Depressants and diuretics.
The writer can be reached at: [email protected]
