Premenstrual syndrome (PMS) is defined as the cyclic occurrence of symptoms that are of sufficient severity to interfere with some aspects of life which appear with consistent and predictable relationship to the luteal phase of the menstrual cycle.

PMS is a very common experience for women of childbearing age. Up to 85% of menstruating women report one or more premenstrual syndrome symptoms but only about 5% – 10% have symptoms severe enough to to interfere with aspects of their life. Symptoms occur during the last week of the luteal phase of the menstrual cycle and remits a few days after the onset of menstruation.



what causes PMS? 

A single, easily understood cause for PMS has not been found yet, but certain patterns have been found to be present in women who have PMS and are considered to be contributory to the etiology of the syndrome.

A variety of hormonal changes have been identified in patients with PMS, particularly an increase in the estrogen to progesterone ratio. Abnormalities in thyroid function, as well as in the production of prolactin (milk producing hormone) have been also identified as a contributory cause for PMS in women. Many patients have been found to show vitamin B6 deficiency as a causative factor.



How to tell if I am suffering from PMS

The typical symptoms of PMS during menstruation  include

  • Mood irritability
  • Abdominal bloating and cramps
  • Breast tenderness
  • Appetite changes
  • Fatigue
  • Decreased concentration



What is Premenstrual dysmorphic disorder?

This is also a cyclic occurrence of menstruation similar to PMS. The difference between this disorder and PMS is in the severity of the emotional symptoms. Typically, emotional symptoms dominate over the physical symptoms in premenstrual dysmorphic disorder. The symptoms include

  • Markedly depressed mood
  • Anxiety
  • Persistent anger
  • Lethargy
  • Difficulty concentrating
  • Insomnia (inability to sleep)
  • Hypersomnia (excessive sleep)
  • Feeling out of control



Considerations in diagnosing PMS and Premenstrual dysmorphic disorder

Diagnosis is based on history taking of symptoms. Women are advised to keep a “symptom dairy” noting the severity and timing of symptoms in relation to menstruation periods. This makes history taking by the clinicians more reliable. Factors to consider when diagnosing PMS or premenstrual dysmorphic disorder are

  • Symptoms must be severe enough to markedly interfere with work, school, usual social activities and relationship with others.
  • Other disorders that can cause similar symptoms should be ruled out first. Lab investigations like full blood count, liver function test, kidney function test, lipid profile, thyroid function test, serum estrogen, progesterone, FSH, LH and prolactin.
  • Prospective daily rating of symptoms  during at least 2 consecutive menstrual cycles must be noted.



How to manage PMS and Premenstrual dysmorphic disorder 

  • Selective Serotonin Re-uptake Inhibitors (SSRIs) are the treatment of choice for severe PMS and premenstrual dysmorphic disorder symptoms.
  • Oral contraceptive used to suppress ovulation may improve physical symptoms of PMS but not the emotional symptoms.
  • Diuretics are indicated for women with significant fluid retention, bloating and edema.
  • Reducing intake of caffeine, salt and alcohol and increasing complex carbohydrate diet during luteal phase can be helpful in mild to moderate PMS symptoms.
  • Calcium carbonate, vitamin B6 and magnesium have been found to be helpful in reducing PMS symptoms.




A. K. Ghosh et al (2008), “women’s health ” Mayo clinic Internal medicine Review , 8th edition (pg 1059). : “All about premenstrual syndrome “


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