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Women
may experience emotional and physical changes prior to
menstruation. The medical term for these changes is
"premenstrual syndrome," commonly called PMS. More
than 150 symptoms are associated with PMS, ranging from breast
tenderness to nausea to anger and irritability.
Premenstrual
emotional and physical changes occur in nearly 80% of
menstruating women. The symptoms vary from woman to woman and
from cycle to cycle. Their intensity ranges from mild to near incapacity.
About 20% to 40% of women who have PMS experience symptoms that
make life difficult and 2.5% to 5% experience PMS that is
debilitating.
It
is not clear what causes premenstrual syndrome. A combination of
physiological, genetic, nutritional, and behavioral factors are
likely involved. There is no diagnostic test for PMS. Tests may
be used rule out other conditions in women who experience severe
symptoms. Emotional and physical changes that are in sync with a
woman’s menstrual cycle are usually a telltale sign.
The
most important indication of PMS is the cyclic nature of
symptoms. There is usually a symptom free time period 1 week
after menstruation ends. At least 25% of patients do not have a
symptom free time period; therefore, they should be evaluated
for other medical or psychiatric conditions.
PMS
can be treated in a variety of ways. The initial and usually
most effective treatment involves non-medical changes in diet
and lifestyle.
Causes
Scientists have been unable to identify a single cause of PMS.
Theories range from hormonal and chemical to nutritional and
psychological. Women whose mother or sisters have PMS are more
likely to have it, so there may be a genetic component. A
combination of genetic, physiological, and environmental causes
are likely.
Hormones
and neurochemicals
The physical, emotional, and psychological changes that occur in
PMS coincide with hormonal changes of the menstrual cycle. PMS
may be a response to declining levels of estrogen and
progesterone that occur just prior to menstruation. The exact
role of the various hormones are not clear. Some neurochemicals
(chemicals that help make up the nervous system) also have been
implicated. Hormones and neurochemicals may interact to produce
PMS.
Mineralocorticoids
are a group of hormones that regulate the body’s fluids and
electrolytes (e.g., sodium, potassium). Changing levels of
mineralocorticoids may cause the bloated feeling that is common
in women with PMS.
Prolactin
stimulates breast development and the formation of milk during
pregnancy and is associated with amenorrhea (abnormal absence of
menstruation) and other gynecologic complications. Excess
prolactin may cause the breast tenderness associated with PMS,
although studies show that suppressing the secretion of excess
prolactin does not relieve symptom.
Prostaglandins
are hormonelike substances that play a role in the luteal phase
of the menstrual cycle, which occurs prior to bleeding. Changing
levels of prostaglandins may be involved in PMS.
Serotonin
and gamma-aminobutyric acid (GABA) are chemicals that relay
signals from one nerve cell to the next (neurotransmitters). Low
levels of serotonin have been linked to depression, and low
levels of GABA are associated with anxiety, both symptoms of
PMS.
Endorphins
are neurochemicals that suppress pain and increase the threshold
to painful stimuli. Low levels of endorphins may be involved in
PMS.
Nutrition
Nutrition probably plays a causal role in PMS. Women can
alleviate many symptoms by changing their diet. Eliminating
certain foods or drinks often reduces symptoms to more tolerable
levels.
Hypoglycemia
(low blood sugar) afflicts many PMS sufferers. Some researchers
speculate that the hypoglycemia is a precursor to PMS.
Depression
Because depression-related symptoms are prevalent in women who
suffer PMS, there may be an underlying psychological condition
that causes or contributes to PMS. Approximately 60% of women
with major affective disorder (e.g., depression) also have PMS,
and more than 30% of women who suffer chronic depression
experience their first depressive episode during a time of
significant hormonal change (e.g., pre-menstrually). In one
study, between 57% and 100% of women who suffered PMS were found
to have had at least one prior major depressive episode,
compared to 0% to 20% of women without PMS.
However,
PMS encompasses more than depression, and by focusing too much
on this aspect, other important physiological factors may be
overlooked.
Signs
and Symptoms
PMS has been characterized by more than 150 symptoms, ranging
from mood swings to weight gain to acne. The symptoms vary from
woman to woman and cycle to cycle. For some women, the symptoms
may be mild or moderate, and for others, they may be so severe
as to be incapacitating. Common symptoms include the following:
Mood-related
("affective") symptoms: depression, sadness,
anxiety, anger, irritability, frequent and severe mood swings
Mental process ("cognitive") symptoms:
decreased concentration, indecision
Pain: headache, breast tenderness, joint and
muscle pain
Nervous system symptoms: insomnia
(sleeplessness), hypersomnia (sleeping for abnormally long
periods of time), anorexia, food cravings, fatigue, lethargy,
agitation, a change in sex drive, clumsiness, dizziness or
vertigo, paresthesia (prickling or tingling sensation)
Gastrointestinal symptoms: nausea, diarrhea,
palpitations (rapid fluttering of the heart), sweating
Fluid and electrolyte symptoms: bloating,
weight gain, oliguria (reduced urination)
Skin symptoms: acne, oily skin, greasy or dry
hair
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