All You Need to Know About Premenstrual Symptoms, Diagnosis, and Treatment

What Is PMS? Why Does It Happen? When women ovulate and are very close to their menstruation, they may encounter some form of mental and physical changes. These changes are considered premenstrual symptoms.  According to …

Managing Premenstrual Symptoms

What Is PMS? Why Does It Happen?

When women ovulate and are very close to their menstruation, they may encounter some form of mental and physical changes. These changes are considered premenstrual symptoms. 

According to researchers, they believe these symptoms come up because of the drop in hormonal levels. The symptoms slowly vanish when a woman goes into day 2 or day 3 of their period. 

Can It Get Severe With Age?

Yes, it can turn out to be severe as you go towards menopause. The more your hormones are unpredictable, the chances of experiencing PMS will be there. Premenstrual symptoms will go away forever once you’ve hit menopause.

Signs and Symptoms

Symptoms of both PMS and PMDD occur during the luteal phase of the menstrual cycle (days 14–28 in a 28-day cycle) and notably subside within 2–3 days after menses begins.

Some women experience positive symptoms, such as a sense of well-being, in the luteal phase of their cycles.

More often, negative symptoms undermine a woman’s ability to function across multiple settings, including work, school, and home.

Premenstrual Syndrome

Although more than 200 symptoms have been associated with PMS, common symptoms include the following [2] –

The Physiological Symptoms

  • Abdominal bloating
  • Back pain
  • Breast pain, tenderness, and/or swelling
  • Headache
  • Muscle aches
  • Weight gain

The Behavioral Symptoms

  • Aggression
  • Changes in sexual interest
  • Dizziness
  • Fatigue
  • Food cravings or overeating
  • Insomnia

Psychological Symptoms

  • Anger
  • Anxiety
  • Confusion
  • Crying and tearfulness
  • Decreased self-esteem
  • Depressed mood
  • Difficulty concentrating
  • Forgetfulness
  • Irritability
  • Loneliness
  • Mood swings
  • Restlessness
  • Tension

What Is the Diagnosis Of PMS?

Premenstrual symptoms cannot be diagnosed with any particular test. It is a behavioral and physical change that can only be observed, and doctors will provide solutions according to those changes. 

The doctors may simply ask you to record everything for 2-3 menstrual cycles. What discomfort you feel, how long they continue, and such. Marking the first day of symptoms and when it goes away can hint at some issues. 

Doctors might or might not ask you to perform mood screening tests or thyroid tests to get a clear picture. 

The American College of Obstetricians and Gynecologists (ACOG) has developed the following diagnostic criteria for the diagnosis of PMS [3]

ACOG Diagnostic Criteria for PMS

Patient reports at least one of each of the following affective and somatic symptoms during the 5 days before menses. Symptoms must appear in three consecutive menstrual cycles –

Affective: Depression, angry outbursts, irritability, anxiety, confusion, social withdrawal

Somatic: Breast tenderness, abdominal bloating, headache, swelling of extremities

Symptoms must also meet the following criteria –

  • Be relieved within 4 days of the onset of menses, without recurrence until at least cycle day 13
  • Be present in the absence of any pharmacologic therapy, hormone ingestion, or drug or alcohol use
  • Be causing identifiable dysfunction in social or economic performance
  • Occur reproducibly during two cycles of prospective recording

Premenstrual Dysphoric Disorder

Reproductive health professionals generally view PMDD as a particularly severe form of PMS with pronounced psychological and emotional symptoms. [4]

Unlike mental health professionals, most Obstetricians/Gynecologists (Ob/Gyns) do not distinguish between PMS and PMDD. The DSM criteria for the diagnosis of PMDD are listed in the chart below. [5]

DSM Criteria for Premenstrual Dysphoric Disorder [5]

A. In most menstrual cycles during the past year, five (or more) of the following symptoms were present for most of the time during the last week of the luteal phase, began to remit within a few days after the onset of the follicular phase, and were absent in the week post menses, with at least one of the symptoms being 1, 2, 3, or 4 –

  • Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts.
  • Marked anxiety, tension, feelings of being “Keyed Up” or “On The Edge.”
  • Marked affective lability (e.g., feeling suddenly sad or tearful or increased sensitivity to rejection).
  • Persistent and marked anger or irritability or increased interpersonal conflicts.
  • Decreased interest in usual activities (e.g., work, school, friends, hobbies).
  • Subjective sense of difficulty in concentrating.
  • Lethargy, easy fatigability, or marked lack of energy.
  • Marked change in appetite, overeating, or specific food cravings.
  • Hypersomnia or insomnia.
  • A subjective sense of being overwhelmed or out of control.
  • Other physical symptoms, such as breast tenderness or swelling, headaches, joint or muscle pain, a sensation of “Bloating,” weight-gain.

B. The disturbance markedly interferes with work or school or with usual social activities and relationships with others (e.g., avoidance of social activities, decreased productivity and efficiency at work or school)

C. The disturbance is not merely an exacerbation of the symptoms of another disorder, such as Major Depressive Disorder, Panic Disorder, Dysthymic Disorder, or Personality Disorder (although it may be superimposed on any of these disorders).

D. Criteria A, B, and C must be confirmed by prospective daily ratings during at least two consecutive somatic cycles. (The diagnosis may be made provisionally prior to this confirmation.)

What Is the Treatment of PMS and PMDD? 

To relieve PMS symptoms, lifestyle changes can be effective and usually works for most women. That being said, the severity can vary from person to person, and this is why doctors sometimes prescribe certain medications.

Here are some common methods that doctors can prescribe –

1. Taking SSRIs, also known as antidepressants, can improve mood in women, and this is sometimes used as the go-to treatment. Selective serotonin reuptake inhibitors such as Zoloft, Prozac, and a few others have shown positive changes in women. 

2. Discomfort in the breast and painful cramps can be relieved through NSAIDs. Medications like Naproxen Sodium, Tylenol or Ibuprofen. According to research, NSAIDs did have some positive effects in tackling discomfort.  

3. Hormonal medicines like combined contraceptives can aid with PMS. They are known to reduce prostaglandins, therefore relieving the contraction in the uterus. Contraceptives like this can make periods less traumatic and can lighten the flow. 

Alternative Ways to Treat These Problems

Apart from medications, many supplements can relieve PMS symptoms. Many people believe that natural supplements are safer than medication, which is true to some extent, but the ingredients’ efficacy can raise some questions, according to medical trials. 

However, there are selected ingredients that have shown good results in elevating libido and lower period pain. Check out a few possibilities –

1. Ginkgo Biloba, A herbal extract that is known for its libido-booster properties, can help with cramps and discomfort. It can be found in many Female enhancement supplements due to its effective nature in promoting blood flow and relaxing muscle tissues. 

2. Supplements containing vitamins and minerals such as magnesium, vitamin b6, vitamin E, calcium, and others are known to ease off pain in some cases. Many bodybuilding supplements for women contain these useful ingredients and can soothe PMS symptoms if taken under expert supervision. 

3. Therapies such as reflexology, acupuncture, and yoga can also come to aid.

4. Exercising regularly can work wonders. Don’t overstress yourself, but do include workouts like cycling and brisk walking for at least 30 mins every day to keep your body healthy and lively. 

What You Should Consider When You Encounter PMS Symptoms?

No matter what you do, you better not start to take medicines on your own if you are experiencing any discomfort. Seek medical attention ASAP and let the doctor decide what’s best for your health.

They might give you thyroid tests and a few others to assess the condition. Ask them what treatments are available and if medicinal alternatives will work better or not.

Follow the healthcare professional’s instructions and try changing your lifestyle for good. Managing Premenstrual Symptoms can be daunting for some people. The medications such as SSRIs, NSAIDs, and even contraceptives can interact negatively, causing further symptoms, but that will vary from person to person.

Seek medical help if things escalate rather than dropping. What can help is having people who care about you by your side, from parents to partners who is understanding and can deal with every possible change. Going through couple counseling can work wonders.

Drug Integrity Associate Audrey Amos is a pharmacist with experience in health communication and has a passion for making health information accessible. She received her Doctor of Pharmacy degree from Butler University. As a Drug Integrity Associate, she audits drug content, addresses drug-related queries

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