Moreover, trials of serotonergic treatments have shown symptom reduction in women with PMS, symptoms respond to selective serotonin reuptake inhibitors SSRIs , which increase the levels of circulating serotonin. The predominant action of estrogen is neuronal excitability, whereas progestogens are inhibitory. Women with PMS have exaggerated responses to normal levels of these hormones, and rapid changes in the levels of these hormones as is experienced in the luteal phase of the menstrual cycle promote the development of symptoms.
Magnesium and calcium deficiencies have been hypothesized to be causes of PMS symptoms. Studies evaluating supplemental therapies have shown improvement in symptoms. It suggests that the premenstrual physical changes remind the woman that she is not fulfilling her traditional role of incubating, nurturing, and rearing a child. This theory is highly subjective and scientifically unprovable.
The sociocultural theory postulates that PMS is a manifestation of a conflict between the societal expectation of the dual role of a woman as both a productive part of the workforce and a mother.
This theory suggests that the onset of menstrual bleeding is an adverse psychological outcome for some women and PMS is a display of maladaptive coping strategies in other to reduce immediate stress.
Diagnosis of PMS can often be difficult because may medical and psychological conditions mimic the symptoms, and there are no laboratory tests to confirm the diagnosis. Women with PMS usually present with complaints from multiple systems, and these symptoms display temporal association with the menstrual cycle luteal phase. Evaluation of women complaining of PMS symptoms includes prospective daily symptom rating for at least two or three menstrual cycles.
She is thus, better at coping with her symptoms. The Endicott Daily Record of Problem Severity chart or the Daily Symptom Rating are tools that can be used to assess the frequency and severity of symptoms described in the luteal phase as against those experienced in the follicular phase of the menstrual cycle [ 14 ]. A physical examination may identify some of the physical symptoms and signs of the disease.
In certain instances, PMS symptoms may be an exacerbation of underlying primary psychiatric condition s. Thus, a psychiatric evaluation may help rule out other common psychiatric conditions such as depression, dysthymia, and anxiety disorders. Additionally, other medical conditions that have a multisystem presentation should be considered.
These include hypothyroidism, systemic lupus erythematosus, endometriosis, anemia, fibromyalgia, chronic fatigue syndrome, fibrocystic breast disease, irritable bowel syndrome, and migraine. Laboratory studies should include complete blood count, thyroid function tests and gynecological hormone profile. This is a condition in which a woman has severe depressive symptoms, tension and irritability before menstruation. It is a more severe form of PMS that affects a small percentage of women within reproductive age resulting in remarkable disability and loss of function.
Symptoms are of sufficient severity as to interfere with work or school, social activities, interpersonal relationships and quality of life.
Patients complain of similar symptoms as seen in PMS but of increased severity. These symptoms, however, are cyclic and disappear with the onset of menses. The most common symptoms of PDMM are irritability, limited concentration, sleep disturbance, mood lability and marked depressed mood. Similarities to MDD are highlighted below.
Markedly depressed mood. A symptom of MDD is depressed mood most of the day, nearly every day. Decreased interest in usual activities. One criterion for MDD is markedly diminished interest or pleasure in all activities. Lethargy, fatigability or lack of energy.
Similarly, patients with MDD have fatigue or loss of energy. In Criterion A in most menstrual cycles during the past year, 5 out of 11 symptoms listed must be present including one of the first four in the last 1—2 weeks before the onset of menses and disappear in the week post-menses.
These symptoms are as follows: Marked lability mood swings. Physical symptoms e. One of the following symptoms must be present: Marked affective lability. One or more of the following symptoms must be present additionally, to reach a total of five symptoms when combined with Criterion B. Decreased interest in usual activities e. Note: the symptoms in criteria A—C must be met for most of the menstrual cycles in the preceding year. The symptoms are associated with clinically significant distress or interference with work, school, usual social activities or relationship with others e.
The disturbance is not merely an exacerbation of the symptoms of another disorder, such as a major depressive disorder, panic disorder, persistent depressive disorder dysthymia or a personality disorder although it may occur concurrently with any of these disorders.
Prospective daily ratings during at least two symptomatic cycles should confirm Criterion A. Note: the diagnosis may be made provisionally prior to this confirmation. The symptoms are not attributable to the physiological effects of a substance, e. PMS may cause significant distress for patients especially the adolescents and as such providing patients with adequate information on the disease including alternative therapies is imperative.
Management of this disorder requires a multi-disciplinary approach involving the general practitioner, the general gynecologist or a gynecologist with particular interest in PMS, a mental health professional psychiatrist, clinical psychologist or counselor , physiotherapist and dietician.
Treatment of PMS is majorly according to the severity of symptoms [ 8 , 12 , 13 , 15 ]. Regular exercise and dietary restrictions often reduce symptoms. Obese patients should be encouraged to join a weight management program.
Dietary modification is often a part of the overall treatment regime. Patients are encouraged to consume smaller meal portions high in carbohydrates. Patients should be counseled to avoid salt, caffeine, alcohol and simple or refined sugars. Diagnostic and Statistical Manual of Mental Disorders. Google Scholar. CrossRef Google Scholar. Berke, Danielle S. Reidy, Brittany Gentile, and Amos Zeichner. Caplan, Paula J. Chrisler, Joan C. Collins, Michelle R.
Dunlap, and Joan C. Chrisler, — London: Praeger. Chrisler, C. Golden, and P. Rozee, 4th ed. Long Grove: Waveland Press. Johnston, Nicole M. Champagne, and Kathleen E. Santa Barbara, CA: Praeger. Coughlin, Patricia C. Craner, Julia R. Sigmon, and Morgan L. Dalton, Katharina, and Wendy M. London: Vermilion. Dickerson, Lori M. Mazyk, and Melissa H. Endicott, Jean, John Nee, and W. Frank, Robert T. Freud, Sigmund. New York: Vintage Google Scholar.
Giles, A. Menstruation and Its Disorders. Gilman, Sander L. Rousseau, and Elaine Showalter. Hysteria Beyond Freud. Greene, Raymond, and Katharina Dalton. Halbreich, Uriel. Rapkin, and Peter J. Schmidt, 9— Halbreich, Uriel, Jean Endicott, S.
Schacht, and J. Hartlage, S. Hoffmann, Diane E. Hollick, Frederick. New York: T. Chen, and Taixiang Wu. King, Helen. London: Routledge. Knaapen, Loes, and George Weisz. Kuczmierczyk, Andrzej R. Labrum, and Carolyn C. Kulkarni, Jayashri. London: Hutchinson. Letson, Sue, and Christine P. Lopez, Laureen M. Kaptein, and Frans M. Maharaj, Shalini, and Kenneth Trevino. Chichester, UK: Wiley. Martin, Emily. Milton Keynes: Open University Press. Moos, Rudolf H. Schmidt, 1—8. Quirke, Stephen.
The Kahun Gynaecological Papyrus. The severity of symptoms can vary by individual and by month. The diagnosis is made when you have more than one recurrent symptom in the correct time frame that is severe enough to cause impairment and is absent between menses and ovulation. Your doctor must also rule out other causes, such as:. Your doctor may ask about any history of depression or mood disorders in your family to determine whether your symptoms are the result of PMS or another condition.
Your doctor may do a thyroid hormone test to ensure that your thyroid gland is working properly, a pregnancy test, and possibly a pelvic exam to check for any gynecological problems. Keeping a diary of your symptoms is another way to determine if you have PMS.
Use a calendar to keep track of your symptoms and menstruation every month. If your symptoms start around the same time each month, PMS is a likely cause. If you have a mild or moderate form of premenstrual syndrome, the treatment options include:. You can take pain medication, such as ibuprofen or aspirin, to alleviate muscle aches, headaches, and stomach cramping.
You can also try a diuretic to stop bloating and water weight gain. Take medications and supplements only as directed by and after speaking with your doctor. Severe PMS symptoms are rare. A small percentage of women who have severe symptoms have premenstrual dysphoric disorder PMDD.
PMDD affects between 3 and 8 percent of women. This is characterized in the new edition of the Diagnostic and Statistical Manual of Mental Disorders. The symptoms of PMDD may occur due to changes in your estrogen and progesterone levels.
A connection between low serotonin levels and PMDD also exists. They may also recommend a psychiatric evaluation. A personal or family history of major depression, substance abuse, trauma, or stress can trigger or worsen PMDD symptoms.
This medication increases serotonin levels in your brain and has many roles in regulating brain chemistry that are not limited to depression. Your doctor may also suggest cognitive behavioral therapy, which is a form of counseling that can help you understand your thoughts and feelings and change your behavior accordingly. A healthy lifestyle and a comprehensive treatment plan can reduce or eliminate the symptoms for most women. When should you see a doctor for bloating and back pain?
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