PMS (premenstrual syndrome) refers to a variety of symptoms that are due to the female menstrual cycle and occur about 4 to 14 days before the onset of menstruation. PMS affects about 75 percent of sexually mature women, with severe impairment of daily life due to PMS observed in about 5 percent of women.
What is PMS?
PMS (premenstrual syndrome) is the term used to describe a range of different physical and/or psychological symptoms that occur monthly during a specific period, in the second half of the menstrual cycle, and usually subside with the onset of menstruation. While mild forms of PMS are not recognized as an illness, severe forms of PMS, especially premenstrual dysphoric disorder, are considered a mental illness that can have a significant negative impact on the daily lives of affected women. Symptomatically, PMS manifests itself by means of varying, complex complaints covering a broad spectrum from headaches and/or abdominal pain, hot flashes as well as water retention to severe psychological impairments such as mood swings, anxiety and depression. In this regard, stress factors, an unbalanced diet with excessive nicotine, alcohol and caffeine consumption, and lack of exercise can exacerbate PMS symptoms.
Causes
The underlying causes of PMS have not yet been conclusively clarified, which can be attributed in part to the fact that in most cases, a combination of causes is present in affected women. On the one hand, hormonal imbalances are suspected, such as a disturbed presence of progesterone and estrogen, which could result from hormonal fluctuations during the menstrual cycle. On the other hand, PMS can be caused by hypothyroidism or disturbed melatonin levels. Besides, some hormonal contraceptives (e.g.: birth control pills) can trigger PMS or increase the symptoms associated with PMS. An unbalanced diet, lack of exercise, excessive alcohol and nicotine consumption, and psychosocial stress factors (problems in the professional and/or family environment) also contribute to an increase in the symptoms typical of PMS.
Symptoms, complaints, and signs
PMS can make the days before menstruation very painful for affected women. However, the specific symptoms can be experienced very differently. Many women experience PMS as an initially slightly pulling, then increasingly strong feeling in the abdomen. PMS can be felt four or more days before menstruation, but often the symptoms occur immediately before menstruation. In addition to symptoms that are also described as cramps in the abdomen, PMS can also affect the appearance of the skin. Many sufferers experience pimples and oily skin in the days leading up to their period. The mind can also be affected by PMS. General malaise, lack of concentration and even depressive moods can be the result of PMS. The altered interaction of hormones shortly before menstruation can lead to feeling irritable, tired and listless. Physical discomfort such as pulling in the abdomen can usually be relieved by painkillers. If the discomfort is felt to be extremely severe, a gynecologist should always be consulted. He must clarify whether another gynecological disease is not causing the severe pain before possibly prescribing special preparations.
Diagnosis and course
To diagnose PMS, the affected woman is asked about her specific complaints and the time of onset as part of a medical history. In addition, it is clarified whether the PMS could be due to hypothyroidism, endometriosis, depression, the onset of menopause or any other causes. In addition, hormone levels can be checked to determine if hormonal imbalance is present. In some cases, especially if several complaints are present, a diary should be kept in which the various complaints are recorded with their respective degrees of severity. As a rule, PMS disappears with the onset of the menopause.Premenstrual syndrome associated with severe symptoms, which severely affects the daily life of the affected woman, should be treated in any case, also because severe, untreated PMS increases the risk of breast cancer.
Complications
PMS, or premenstrual syndrome, is a major burden for many women. However, seven percent of those affected may experience such severe symptoms that even their entire social environment is severely affected. This is then referred to as premenstrual dysphoric disorder. Premenstrual dysphoric disorder is a real mental illness that can occur as part of premenstrual syndrome. Affected women become severely irritable and sometimes highly aggressive. Although they know it is wrong, these women often show behavior during this phase that they would strictly reject in normal times. Thus, they may become physical, hit their child, have screaming fits, or even throw objects. Women affected by premenstrual dysphoric disorder suffer a loss of control during this period. Therefore, even the realization that their behavior is wrong does not help them. The biggest risk for these women is that they can destroy their social environment with their manner. As a result, they may then divorce or even lose their children. Also the vocational perspective is often impaired by it illness-conditionally. In the long term, social isolation can thus result, which in addition often leads to further chronic mental illnesses such as depression, in addition to the premenstrual complaints.
When should you go to the doctor?
Premenstrual syndrome is not a disease in the strict sense and does not need to be treated. Therefore, if symptoms are mild to moderate, it is not urgent to see a doctor. Nevertheless, those affected should describe their symptoms during the annual gynecological checkup. However, action is required if severe psychological and physical symptoms occur repeatedly in nine out of twelve cycles. In these cases, it is advisable to consult a doctor, as the complaints can rarely be based on serious illnesses. The first point of contact is either the family doctor or the gynecologist. Which doctor should be consulted depends on the symptoms present in each case. In the case of psychological problems, it may also be advisable to consult an endocrinologist, psychiatrist or psychologist. If the symptoms are mainly physical, those affected should consult a gynecologist or alternative practitioner. Basically, many general practitioners and specialists are not appropriately trained with regard to premenstrual syndrome. Therefore, in many cases it may also be advisable to see several doctors. Conventional medical therapy approaches are not effective in some women. In these cases, it is recommended that alternative approaches also be considered.
Treatment and therapy
In the case of PMS, therapy depends to a large extent on the underlying complaints as well as the level of suffering experienced by each affected woman individually. For example, mild PMS need not require therapy if the symptoms associated with it only slightly interfere with the daily life of the affected person. To treat mild PMS, in many cases it is sufficient to learn relaxation techniques such as autogenic training or progressive muscle relaxation to avoid or minimize the effects of stress factors. Hormonal contraceptives containing progestins are also used to treat PMS. Anti-inflammatory drugs are used to relieve pain, and a low-salt, easily digested diet with no alcohol, nicotine or caffeine and/or diuretics can be helpful against water retention. In some cases, herbal remedies (wolfstrappkraut, monk’s pepper) and/or an additional increase in magnesium and vitamin B intake provide relief. In individual cases, psychological support for the affected woman through behavioral or psychotherapy may be indicated, while antidepressants (such as amitriptyline) are used therapeutically if depression is present.
Outlook and prognosis
Premenstrual syndrome depends on many facilitating factors. Girls and young women who suffer from PMS may notice a significant improvement in symptoms toward the end of puberty and entry into adulthood.At best, they experience no symptoms at all or only mild symptoms as adult women. If an adult patient still suffers from PMS, she will most likely experience the symptoms until menopause. There are factors that can make the symptoms more severe or that can alleviate them. Consumption of nicotine and caffeine can have a worsening effect, while combinations of certain fatty acids in the diet can alleviate the symptoms. A change in diet can therefore have a positive effect on well-being. Lack of exercise can also be a reason why premenstrual symptoms are more severe than necessary. Sport and fitness can have a preventive effect. Certain conditions such as thyroid disorders, fungal infections, or even sleep problems also aggravate PMS symptoms. So although premenstrual syndrome is not curable, the affected woman can still try to relieve the symptoms without taking medication. If the symptoms are severe, painkillers can be taken to relieve the symptoms to the point where normal daily life can be managed so that the social consequences of PMS are not unnecessarily severe.
Prevention
PMS cannot be specifically prevented due to the fact that its causes have not been conclusively determined. However, the extent of the respective symptoms can be positively influenced, if necessary, by a balanced diet while avoiding excessive nicotine, alcohol and caffeine consumption, sports activity and relaxation techniques to reduce stress. In addition, the risk of disease is increased in obesity (overweight). Accordingly, weight reduction can minimize the risk of developing PMS.
Follow-up
In the field of PMS, to speak of aftercare is not quite correct, since it is a symptom that usually repeats monthly. If the symptoms experienced by the woman are particularly severe, monthly aftercare can be provided in the sense of supporting physical and psychological regeneration. This can be done through warm baths, gentle endurance training or massages and depends on the individual’s well-being and tastes. Adequate drinking, a healthy diet and sufficient sleep can also be integrated into the aftercare following the often very unpleasant days of premenstrual syndrome. Often, women can self-treat PMS with herbal remedies such as monk’s pepper. If this is successful, part of the aftercare is to reliably follow the dosage. Regular visits to the gynecologist are also included in aftercare to make sure that, for example, breast tenderness thought to be PMS is not hiding another condition. Learning relaxation techniques is also a way to make follow-up care meaningful. PMR (progressive muscle relaxation), AT (autogenic training), fantasy journeys and yoga are just a few of many examples. Aftercare also involves the woman observing what is particularly good for her during the PMS period. By keeping a cycle calendar, these measures can be started early.
What you can do yourself
PMS (premenstrual syndrome) is a common and regularly occurring phenomenon. For affected women, there is a whole range of ways to alleviate the unpleasant symptoms through self-help in everyday life often noticeable. This often succeeds particularly reliably because the occurrence of PMS can be easily predicted due to its dependence on the woman’s monthly cycle. In this context, self-help is possible for both the physical and the psychological complaints that PMS brings with it as a very individual pattern of complaints. In the physical area, the unpleasant breast tenderness and skin impurities are particularly worth mentioning. Monk’s pepper preparations are often suitable for reducing the feelings of tension in the breast. A well-supporting bra ensures that the pain that often occurs during movement is reduced. Skin blemishes can often be alleviated with mild antiseptic cleansing products. On the mental front, the range of possible complaints, such as anxiety or depressive moods, as well as fatigue, can be alleviated with physical activity. Exercise in the fresh air, such as walking or swimming, is particularly recommended. Those who want to take it a little easier will find balance in yoga or progressive muscle relaxation.It also often helps to schedule stressful personal or professional obligations so that they do not fall during the PMS phase and do not put additional strain on the sufferer.
