The famous PMS, also known as premenstrual syndrome, is a term that refers to a set of physical and behavioral symptoms that occur cyclically during the second half of the menstrual cycle, ie in the period of the cycle between ovulation and the next menstruation.
For most women, PMS is only a temporary nuisance, which is easily tolerated and does not cause major inconvenience. However, about 1 in 10 women presents with severe premenstrual tension, with high stress and angry outbursts, which can cause social, professional and personal difficulties.
The premenstrual syndrome is a set of signs and symptoms, both physical and psychological, that arise in the final phase of the menstrual cycle, days before menstruation falls. About 70% to 80% of women are affected by a change in mood in the pre-menstrual period.
Women with PMS may present from mild mood changes to severe behavioral symptoms, with a great impact on quality of life and social and professional life.
PMS presents a peak incidence between 25 and 35 years of age. The most severe form of PMS occurs in up to 8-10% of cases and is called premenstrual dysphoric disorder (PMDD).
There is still no complete explanation as to why PMS arises. Current studies suggest that there is an interaction between the hormones produced by the ovaries in the second half of the menstrual cycle and some central nervous system neurotransmitters, such as serotonin and endorphin, which are associated with mood control.
It is not known exactly why some women have very symptomatic premenstrual syndrome and others have no symptoms. It has already been proven that there are no differences between estrogen and progesterone levels among women with and without MPD. It is therefore thought that some women are more sensitive to fluctuations in brain neurotransmitters caused by the physiological hormonal changes of the menstrual cycle.
Also, it has not yet been possible to prove any relationship between the different personality types with the occurrence of MPD. Women who are usually calm may have PMS, while more restless and nervous women may not have it. Likewise, stressors do not seem to play as important a role in the onset of PMS as previously thought. In fact, it is far more common for premenstrual tension to cause stress than the other way around.
Feeding interference in symptoms is also controversial. Excess salt, alcohol and caffeine may cause changes in neurotransmitter levels, however, it has not been possible to prove an unequivocal relationship between diet and PMS.
Some studies have shown a relationship between the low consumption of vitamins and minerals with PMS, but there is no evidence that simply replacing these vitamins improves the symptoms of all women with premenstrual tension.
Therefore, there is no scientific basis to support any type of PMS treatment that is based solely on dietary changes. Some women may even report some improvement with dietary changes, probably because people with healthy eating practices also tend to have other, healthier lifestyles, which creates a sense of well-being.
Symptoms of PMS and PMDD may be confused with those of some psychiatric illnesses, such as depression and anxiety disorders. Patients with depression may experience worsening of symptoms in the pre-menstrual period and improvement after menstruation. However, being depressive is never completely free of symptoms. In premenstrual syndrome, symptoms disappear completely after menstruation.
The close temporal relationship of worsening of symptoms in the second half of the menstrual cycle and their complete resolution after menstruation is the basis for the diagnosis of PMS.
There is no definitive test or examination for the diagnosis of PMS. The diagnosis is made after a careful evaluation of the patient's clinical history and physical examination. Blood tests are completely normal in PMS, but are required to rule out other causes for symptoms, such as thyroid abnormalities.
As already mentioned, PMDD is a form of severe PMS. Usually, the patient has more intense symptoms, such as angry outbursts and anxiety attacks. The patient with premenstrual dysphoric disorder, unlike simple PMS, presents problems of interpersonal relationship and frequently enters conflicts in the work, which can generate damages in the intimate and professional life. PMDD is a PMS that effectively disrupts a woman's life.
To aid in diagnosis, the physician can use questionnaires to fill out the patient, reporting their symptoms throughout the day of the menstrual cycle.
A number of medications may be helpful in controlling PMS. However, many women manage to control their symptoms only with lifestyle changes.
Regular exercise and a balanced diet rich in fruits and vegetables and low in salt can help more than you can imagine. Relaxation techniques also help. In some cases, vitamin supplementation may be indicated by your doctor, although this practice is not scientifically proven.
In the most symptomatic cases or those with a diagnosis of PMDD, drug therapy should be used.
Serotonin reuptake inhibitor antidepressants are the first-line drugs. The best known drugs of this class are Sertraline (known by the trade name Dieloft TPM), Fluoxetine, Paroxetine and Citalopram.
The use of contraceptives has divergent effects. Some women report a great improvement in the picture, but others complain of worsening. Yaz is a pill specifically approved for PMS control and is effective in more than 60% of cases, making it the best contraceptive.
In severe cases refractory to conventional treatment, drugs that inhibit the production of estrogen and progesterone through the ovary, called GnRH (Leuprolide) agonists, may be used. These drugs cause a menopausal drug, so for prolonged use, your doctor will have to do estrogen and progesterone replacement.
The vast majority of women get good PMS control with treatment, but in more severe cases of PMDD, when all treatments fail, surgery for removal of the ovaries is an option that should be proposed for women who do not want more have children.
