Premenstrual Syndrome

• Premenstrual Syndrome (PMS)


  A broad term that encompasses a wide range of physical, behavioural and psychological symptoms that occur before a period
• Premenstrual Syndrome (PMS)


  • Symptoms range from mild to very severe
  • Severe symptoms, especially mood symptoms, affect approximately 5% of patients and can interfere with daily functioning and relationships
  • In these women, a diagnosis of premenstrual dysphoric disorder is given
• Epidemiology of PMS


  • No marked racial or ethnic differences in prevalence
  • Age appears to be a risk factor: most common in the 30-40 age group
  • Can occur in 20s
  • Over 90% of women have experienced PMS symptoms, but only 20% seek medical help, and 13% to 25% have taken time off from work
• Aetiology of PMS


  • The precise pathophysiology is still unclear
  • A number of theories have been proposed, e.g. excess oestrogen and a lack of progesterone or ovarian function
  • Most researchers now believe PMS is a complex interaction between ovarian steroids and the neurotransmitters serotonin and gamma-aminobutyric acid (GABA)
• Physical symptoms of PMS

  • Swelling
  • Breast tenderness
  • Aches
  • Headache
  • Bloating/weight
• Behavioural symptoms of PMS


  • Sleep disturbances
  • Appetite changes
  • Poor concentration
  • Decreased interest
  • Social withdrawal
• Psychological symptoms of PMS

  • Irritability
  • Mood swings
  • Anxiety, tension
  • Depression
  • Feeling out of control
• Onset of PMS symptoms

  Symptoms experienced 7-14 days before, and that disappear a few hours after the onset of menses, are suggestive of PMS
• Age of PMS patient

  PMS is most common in women in their 30s and 40s
• Presenting symptoms of PMS


  Patients with PMS will normally have symptoms suggestive of mental health disorders, such as a depressed mood, insomnia and irritability. This can make excluding mental health disorders, such as depression, difficult. However, the cyclic nature of the symptoms in conjunction with symptoms such as breast tenderness, bloating and fluid retention point to PMS.
• Treatments for PMS


  • Calcium (1000-1200 mg a day)
  • Magnesium (200-400 mg a day during the two weeks before a period)
  • Agnus castus
  • Pyridoxine (vitamin B6)
  • Evening primrose oil
• Calcium


  High doses could cause constipation
• Pyridoxine (vitamin B6)


  • Evidence to support conflicting
  • Take in the two weeks before periods, or every day
  • Do not exceed 10 mg a day
  • High doses associated with neuropathy
• Vitax agnus-castus


  • There are a number of preparations available in the UK; however, there is little standardization of dosing
  • Generally well-tolerated, with no known interactions, but limited adverse effects, mainly skin reactions, can occur