What is premenstrual syndrome?
The vast majority of women of childbearing age experience a series of physical and / or psychological changes in the days prior to the onset of menstruation. For most women, the symptoms are mild and do not interfere with their daily lives. However, for a small percentage of women, the symptoms are so serious that they are very afraid to go through this time of the month.
There are about one hundred recognized symptoms that may be due to PMS, but fortunately, most women experience only a few.
None of the symptoms appear only in PMS, as they may be symptoms associated with other diseases such as depression, hyperthyroidism (excess thyroid hormones) or hypothyroidism (thyroid hormone defect). However, the symptoms of PMS are clearly related to the onset and end of menstruation. The most common symptoms are:
- Humor changes
- Loss of nerves with ease
- Loss of confidence
- Easy crying
- Lack of concentration
- Breast pain
- Abdominal distension
- Weight gain
- Edema of legs
- Headache and migraines
How does a woman know that she has PMS?
Blood and urine tests are often helpful in ruling out a disease with PMS-like symptoms. However, there are no laboratory tests that can diagnose PMS.
The diagnosis of PMS is based on the type of symptoms (such as those mentioned above) and the special moment in which they occur (before menstruation only). Most women with PMS have a gradual worsening of their symptoms during the week prior to menstruation with a gradual and rapid disappearance of the same when the menstruation arrives. This is not always the case, and sometimes the symptoms persist during the period and even one or two days after the end.
The diagnosis of PMS can only be made through the elaboration of a diary where the type of symptoms, their severity and their variation during the menstrual cycle are collected. This data collection must be done for at least three consecutive months. The diagnosis of PMS is usually made if the symptoms do not appear at least ten days a month.
What causes PMS?
It is not known for sure what causes this syndrome. Most doctors believe that it is produced by fluctuating levels of female hormones that takes place after ovulation. These fluctuations may be a direct cause of some of the physical symptoms of the syndrome, such as meteorism. Patients with PMS may have a low level of certain brain substances (serotonin) which may explain some of the non-physical symptoms of the syndrome, such as irritability, depression, and mood swings.
PMS is not caused by any underlying abnormality in the female internal genitalia, nor is it caused by any hormonal defect. Understanding PMS is the first step in overcoming the disease.
When should a woman be treated?
Recognizing that your symptoms are due to PMS is a critical first step. For most women, symptoms are only a small nuisance that can be recognized, anticipated and accepted by themselves. These women may seek advice from their doctors, but they do not need any specific treatment.
However, for a minority of women, PMS is intense enough to affect their quality of work and personal life. It is understandable and advisable that these women visit their doctors to seek a treatment for their ills.
What are the treatments that available?
Confirming the diagnosis and setting the objectives is the first step. There are many treatments for PMS, most of which offer a short-term benefit, but few bring relief beyond a few months. The reason for this is by the “placebo effect”. A placebo is a treatment that has little efficacy but which makes the patient better because of the confidence she has in that treatment. It is well known that patients with most illnesses (including PMS) perceive an improvement in their medical conditions with a placebo treatment, at least initially.
The visit to the family doctor is the first step that a woman suffering from PMS must give. Discussing with your doctor the discomfort caused by PMS may be enough. In other cases, the aid should focus more on a family planning center. Severe cases, or those that do not respond to the simplest treatments, should be referred to the gynecologist and / or psychiatrist / psychologist, depending on the type of symptoms present.
Treatment depends on the nature of the symptoms and their severity. For women who only have minor discomfort, a change in diet, lifestyle, a reduction or suppression of alcohol, coffee and tobacco may be enough to improve their symptoms and make them more bearable. The general practitioner can give you precise guidance on these changes.
Medical treatments vary according to their effects and effectiveness. The following treatments have been used in PMS with greater or lesser effectiveness.
Vitamin B6 is better known as pyridoxine. It is commonly recommended for mood disorders and irritability. There are studies of its use for mild symptoms, but it is important not to take it in high doses. You should consult your doctor before starting treatment.
Evening Primrose Oil
These capsules are used when breast pain is the main symptom.
Bromocriptine and Cabergoline
These medicines are also used against breast pain. They need a prescription.
They can improve leg edema. Abdominal distension is not relieved, which is not caused by fluid retention, but by relaxation and distention of the muscles of the wall of the intestine. They should be prescribed by the doctor and should only be taken a few days a month, in the lowest doses possible.
Antidepressants called serotonin reuptake inhibitors (SSRIs) are more commonly used, such as Prozac in the treatment of severe PMS, when symptoms are mostly depression, mood swings, irritability, and so on. The results are often good and supported by rigorous scientific studies; However, side effects can be a problem. The visit to the general practitioner, gynecologist or psychiatrist is essential before starting this type of treatment.
Non-hormonal treatments Progestogens
They are a type of female hormone that is usually taken 10 or 14 days before the start of menstruation. Progestogens are widely prescribed for PMS and have relatively few side effects. It is thought that PMS may be due to a reduction in blood levels of progesterone, but at present this claim has not been scientifically proven. Some women find an improvement in their symptoms for a short period of time and when they are mild. However, there are no scientific studies demonstrating that these hormones are beneficial for the treatment of PMS.
Oral Contraceptives (ACO)
They have been prescribed frequently for the treatment of PMS, especially if the woman requires contraception. OCPs inhibit ovulation and reduce natural fluctuations in female hormones during the menstrual cycle, which appear to play an important role in the development of PMS. Unfortunately, some women have this syndrome during OCI because of the hormones contained in the pills. Although it seems logical to use ACO in PMS, there is little scientific evidence that its use is entirely beneficial.
It is a synthetic hormone derived from male hormones. Its use in PMS is supported by scientific studies, but due to its adverse effects is not an extended treatment. Its prescription must be done in low doses, and even so it is not tolerated by many women. This treatment should always be indicated by a doctor. Due to its effects on gestation, it should be avoided during pregnancy.
The use of estrogens (a female hormone) in women can suppress ovulation and reduce the hormonal fluctuations of the menstrual cycle. There is scientific evidence to support its use in PMS. It should be used under medical supervision and in low doses. It should be associated with a gestagen for at least 10 days before menstruation.
They are potent drugs that inhibit the function of the pituitary (gland that regulates the menstrual cycles). They produce a temporary and reversible menopause, by inhibiting the function of the ovaries. These drugs should be prescribed by gynecologists and their use should not exceed 6 months. GnRH analogs can be used to confirm the diagnosis of PMS. They should only be used in cases of severe PMS that do not respond to other treatments.
This device is an intrauterine contraceptive method containing a small dose of gestagen which is released gradually. In many women, this type of device reduces the amount and duration of their rules and sometimes improves mild PMS. There is no scientific evidence for use in PMS. This device may be used in combination with estrogen treatments (eg, patches)
Hormone treatments Surgery
It is indicated for a minority of patients suffering from severe PMS. It consists of the extirpation of the ovaries and the end of the reproductive period of the woman with the consequent entry into menopause. This step should always be carefully weighed, and the woman should be advised by a gynecologist to propose another type of treatment (eg GnRH analogues).