Premenstrual Syndrome (PMS)

Medically Reviewed by Dr Sravya, MBBS, MS 

What is Premenstrual Syndrome (PMS)?

Premenstrual syndrome (PMS) is a group of physical, emotional, and behavioral symptoms that women may experience in the days before their menstrual period. PMS usually occurs during the luteal phase of the menstrual cycle, which comes after ovulation, and it lasts until the menstruation starts.

What causes PMS?

Some other symptoms may be the reasons for PMS, such as stress, diet, exercise, sleep, or genetics.

The exact cause of PMS is not fully understood yet, but it is most likely associated with the hormonal level fluctuations happening during the menstrual cycle. Estrogen and progesterone levels rise and fall during different phases of the cycle, and these hormonal changes can interfere with the functioning of the various systems in the body, alter mood and behavior, and cause some other physical symptoms.

premenstrual syndrome

1. Hormonal changes

Fluctuations in estrogen and progesterone levels during the menstrual cycle are thought to be a primary factor for PMS. The symptoms can worsen during the luteal phase of the menstrual cycle, which is the period between ovulation and the start of menstruation when progesterone levels rise.

Other than estrogen and progesterone, some hormones and chemicals produced in the body can cause premenstrual syndrome.

Researchers are still learning about the role of neurotransmitters in PMS. However, it is thought that neurotransmitters like serotonin, dopamine, and gamma-aminobutyric acid (GABA) may also be affected during the menstrual cycle and potentially play a role in PMS symptoms.

(i) Effect of Serotonin levels:

Serotonin is a neurotransmitter that is responsible for mood and emotional well-being. Changes in hormone levels during the menstrual cycle also have an impact on serotonin levels, contributing to mood swings and emotional symptoms associated with PMS.

(ii) Effect of Dopamine:

Dopamine is a neurotransmitter that has an impact on reward and motivation. The dopamine levels slightly decrease during this period. The low levels of dopamine have been associated with depression and lack of motivation.

(iii) Effect of GABA:

GABA is a neurotransmitter that functions for calming and relaxation. The decreased levels of GABA can develop anxiety and irritability.

(iv) Chemical changes in the brain:

Hormonal fluctuations can lead to changes in brain chemicals, which may contribute to the emotional and behavioural symptoms of PMS.

2. Genetics:

There may be a genetic predisposition to developing PMS. Many studies have shown that women with a family history of PMS are more likely to experience it themselves.

In some cases, the genes that are responsible for producing proteins that are involved in a variety of bodily functions, including mood regulation, hormone production, and pain perception, are active for PMS symptoms.

Another study has shown that women who had a certain variation in the estrogen receptor gene were more likely to develop PMS symptoms such as breast tenderness, bloating, and headaches.

There are some ways to manage these PMS symptoms, like having a healthy diet, doing regular exercise, managing stress, and avoiding alcohol and caffeine.

3. Stress

Stress can exacerbate PMS symptoms and may play a role in the severity of the condition. If you are stressed during the days before your menstrual cycle, then your body releases hormones like cortisol and adrenaline. These are hormones that trigger PMS symptoms such as anxiety, irritability, mood swings, and depression.

Stress can make you unable to manage symptoms if you are stressed, then you may be more likely to eat unhealthy foods, skip your meals, and avoid doing exercise, which makes it worse.

Doing meditation every day can be useful for you to managing stress

4. Lifestyle factors

Poor diet, lack of exercise, and inadequate sleep can affect PMS symptoms because self-care in premenstrual syndrome is very important.

It’s very important to note that not all women experience PMS, and the severity of symptoms can vary widely from person to person.

Those women who follow self-care for PMS regularly and have a healthy lifestyle do not experience extreme PMS. Additionally, some women can experience premenstrual dysphoric disorder, which is a more severe and less common form of PMS.

What are the symptoms associated with PMS?

Premenstrual syndrome (PMS) is characterized by various physical, emotional, and behavioural symptoms that develop while leading up to menstruation. These symptoms specifically occur during the luteal phase of the menstrual cycle and start to improve or disappear with the onset of the menstrual cycle.

This is a very common condition that affects about 85% of women of reproductive age. The severity of symptoms can vary from woman to woman, and not necessarily everyone would experience all the symptoms.

Some common symptoms of PMS include:

1. Physical symptoms:

(i) Breast tenderness or swelling:

Breast tenderness or breast swelling is a very common symptom associated with premenstrual syndrome (PMS). Many women experience changes in their breasts during the luteal phase of the menstrual cycle. During this phase, the hormone progesterone levels increase. An increase in progesterone can cause water retention, and eventually, it may also stimulate the growth of milk glands and ducts in the breasts.

Additionally, hormonal fluctuations, particularly such as the rise and fall of estrogen and progesterone levels, can lead to breast tissue changes and increased sensitivity, resulting in breast tenderness.

The grade of breast tenderness or swelling can vary from woman to woman and from cycle to cycle. Some women may experience mild discomfort, while others may have more significant or extreme pain or swelling.

Breast tenderness can be relieved by wearing a supportive bra, applying a warm compress, taking OTC pain reliever, and avoiding caffeine or alcohol.

(ii) Bloating or water retention

Bloating, also known as abdominal bulge, is a common symptom of PMS. Bloating is because of a combination of hormonal and physical changes that take place in the body during the menstrual cycle.

Estrogen hormone gives rise to the retention of water in the body, while progesterone can bring the muscles in the digestive system to relax, which results in slow-down digestion and leads to bloating.

Bloating can be avoided by reducing salt intake, drinking a good amount of water, and eating small and frequent meals.

(iii) Abdominal cramps or pain

Abdominal pain or cramps are also called dysmenorrhea, and it is caused by uterine contractions. Abdominal cramps are very common before and during menstruation.

Dysmenorrhea can be mild or severe and can remain for a few hours or a few days.

To get relief from this, you can follow self-care in premenstrual syndrome, such as applying a heating pad or hot water bottle to the lower abdomen, getting enough sleep, and avoiding caffeine and alcohol.

(iv) Headache or migraine

Headache, usually of migrainous type, is one of the symptoms frequently reported in the diagnostic criteria for PMS.

Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended to treat because they are effective in preventing menstrual migraines.

To relieve headaches, you should manage stress, identify and avoid triggers, and meditate daily.

(v) Muscle aches and joint pain

Changes in electrolyte levels are minerals that help to regulate muscle and nerve function and can contribute to muscle aches and joint pain.

Several things can be done to relieve muscle aches and joint pain, including:

Over-the-counter pain relievers: OTC pain relievers, such as NSAIDs like ibuprofen or acetaminophen, can help relieve pain and inflammation.

Heat therapy: Applying a heating pad or hot water bottle to the paining area can help relax the muscles and reduce pain and inflammation.

Massage: Massage can help to relax the muscles and reduce pain and inflammation.

Exercise: Exercise can help to improve blood circulation and reduce pain and inflammation.

Exercising will relieve the joint or muscle spasm. However, it is important to avoid intense exercise or workouts during PMS, as this can worsen the symptoms.

(vi) Fatigue or tiredness

Feeling tired at the time of your period is completely normal. Many factors affect your alertness and energy of doing work.

At such times, instead of feeling tired, the thing you can do is to take some time away from stressors and try to get time for yourself to relax your body and mind. Don’t feel guilty for not being active because it’s not permanent.

During these days, Listen to your body and rest whenever you need to, but avoid napping during the day. You should get regular exposure to sunlight, which will help to relax your mind and body. The most important self-care in PMS is staying hydrated by drinking plenty of water throughout the day and avoiding unhealthy diet habits and intense exercise.

During the menstrual period, your body is more prone to viral or bacterial infection which can make you sick and feel tired. So, you should maintain the hygiene.

2.Emotional and behavioural symptoms:

During PMS, women can experience some emotional and behavioural changes. During this period, having mood swings, Irritability or increased sensitivity, anxiety or nervousness, feeling overwhelmed or crying, low mood or depression, and facing difficulty in concentrating on things is completely normal. Many women also experience behavioural changes in everyday life.

A woman may withdraw herself from social activities and will prefer being isolated. She may also feel changes in appetite and sleep patterns, such as difficulty falling asleep or frequently waking up while asleep.

If you experience significant discomfort or disruption in your life due to PMS symptoms, it’s essential to consult a healthcare professional. They can help to diagnose PMS, rule out other potential causes for your symptoms, and recommend appropriate management strategies and self-care in premenstrual syndrome; hormonal therapies and medications are among the various options that may be considered to alleviate PMS symptoms.

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