What is pre-menstrual tension syndrome (PMS) ?
Premenstrual syndrome is a picture that starts after the ovulation function of the menstrual cycle in women and manifests itself with physical symptoms such as breast swelling, headache, weakness and weight gain in the period called the late luteal phase, and psychological symptoms such as depressive mood, irritability and tension. This picture typically disappears with the onset of menstruation. Although this syndrome is seen in 80 percent of the female population, it is severe enough to be clinically significant in women in approximately 5 percent of the population. If these symptoms are clinically or socially effective, it is classified as a psychiatric disorder called Premenstrual Dysphoric Disorder or Late Luteal Phase Disorder.
What are the causes of PMS ?
The causes of premenstrual tension syndrome have not been fully determined. However, the most up-to-date explanation of the causes of PMS; is the assumption of sensitivity in the central nervous system. According to this assumption, PMS is a hypersensitivity to "normal" changes in hormones rather than a hormonal imbalance. In women who are sensitive to normal changes in hormonal functioning that occur in a cyclical manner depending on the menstrual cycle, these changes trigger PMS-related biochemical events in the central nervous system and other target tissues around it. This susceptibility depends on many factors and is partially determined by genetics.
Serotonin hormone plays the most important role in the processes that lead to the emergence of premenstrual tension symptoms in the central nervous system. Fluctuations in serotonin, a brain chemical thought to play a crucial role in mood states, can trigger PMS symptoms. Studies in women with premenstrual tension syndrome (PMS) have shown many differences in the serotonergic system compared to normal women. The fact that many symptoms of PMS are similar to psychiatric conditions related to the serotonergic system and the relations between the serotonergic system and progesterone are presented as supporting the serotonergic view. Progesterone is produced primarily in the ovaries, and while progesterone itself is anxiety-provoking, its products are anti-anxiety. Progesterone increases the reuptake of serotonin, causing an increase in the serotonin cycle.
What are PMS symptoms ?
PMS has mental, behavioral and physical symptoms.
Mental and behavioral symptoms:
-Decreased interest in the environment
-Increased sexual desire
-Nervousness, tension, anxiety and lack of attention
- Appetite changes and food cravings
-Enlargement and tenderness of the breasts
-Edema in the body
-Headache with weight gain up to 2-3 kilos,
- Increased appetite
-Acne on the skin
-Joint or muscle pain
It has been stated that all these symptoms pass quickly with the onset of menstrual bleeding.
How is PMS diagnosed ?
There are no unique physical findings or laboratory tests to positively diagnose premenstrual syndrome. If the symptoms are part of the predictable premenstrual pattern, a particular symptom may be attributed to PMS by the doctor. To help establish a premenstrual pattern, the doctor may ask the doctor to record signs and symptoms on a calendar or a diary for at least two menstrual cycles. It may be helpful to note the day PMS symptoms were first noticed and the day they disappeared. In addition, it is necessary to make sure that the days when the period starts and ends are marked.
It should be noted that some conditions can mimic PMS, including chronic fatigue syndrome, thyroid disorders, and mood disorders such as depression and anxiety. Tests such as thyroid function testing or mood screening tests may be ordered to make this distinction and help provide a clear diagnosis.
What are the types of pre-menus tension syndrome ?
Typical symptoms of premenstrual tension syndrome may manifest in different ways.
*First type: Although it is the most common type, it starts in the late premenstrual period, which is first described by the original syndrome, that is, in the days close to the menstrual period.
*Second type: It progresses with ovulation, that is, with the ovulation period, when the symptoms start and resolve spontaneously within a day or two and then reappear in the premenstrual period.
*Third type: Symptoms begin with ovulation and increase continuously and reach their peak in the luteal phase. This different course and pattern in the symptoms are similar in almost every menstrual cycle of the woman who has this disorder.
How is PMS treated ?
The main goal of treatment in patients with PMS is to reduce symptoms, improve social and occupational functionality, and thus increase quality of life. Treatment-oriented approaches are divided into biological (drug treatments) and psychological approaches (psychotherapy).
-Psychological approaches: Psychoeducation and lifestyle regulation measures are usually sufficient for women with mild symptoms. However, exercise, relaxation, and cognitive behavioral therapy are recommended. These drug-free methods can help alleviate premenstrual symptoms.
-Birth control pills: If the patient's premenstrual symptoms started or worsened after using contraceptives, then it would be helpful to switch to another preparation or use another contraceptive method.
-Drug therapy: The most commonly used drugs in premenstrual tension syndrome (PMS) are antidepressant drugs from the serotonin reuptake inhibitor group, which act on serotonin, which is thought to be effective in the pathophysiology as well. There are two main methods of using SSRIs. The first is the use of these drugs in the last two weeks of the menstrual cycle (intermittent), and the second is their continuous use. In intermittent use, the drug is started during ovulation and stopped 1-2 days after the start of menstruation.
-Hormonal therapy: One of the biological treatments used in PMS is hormonal treatments. Hormonal therapy strategies are based on the premenstrual symptoms being related to hormonal changes in the menstrual cycle, and in most of them the aim is to suppress ovulation.
-Nutrition and lifestyle changes: Some dietary supplements are also recommended in PMS. However, there is little scientific evidence to show that these supplements are effective, with some exceptions. These patients are also recommended to spend more time sleeping, reduce caffeine, salt, nicotine and alcohol intake, and supplementation of vitamin B6, magnesium, calcium and vitamin D during the period of premenstrual tension syndrome symptoms. Promising agents include calcium supplementation, vitamin B6 (pyridoxine) supplementation, B1 and vitamin E, a diet consisting of complex carbohydrates, and the use of vitex agnus castus (Chassis Tree), especially if pelvic pain is accompanied. A decrease in psychiatric symptoms was found in women who took 80 mg of vitamin B6 daily. Vitex agnus castus acts as a dopamine agonist, reducing follicle-stimulating hormone (FSH) or prolactin levels, and is beneficial for the physical rather than the psychological symptoms of PMS.
FREQUENTLY ASKED QUESTIONS
What is the most common age range for premenstrual syndrome (PMS) ?
PMS (premenstrual syndrome) symptoms begin at any age after menarche, that is, the onset of menstruation. The average age of onset is around 26. PMS symptoms gradually increase with age and decrease as you approach menopause.
When to see a doctor for PMS ?
If premenstrual syndrome cannot be managed with lifestyle changes and PMS symptoms affect health and daily activities, a specialist doctor should be consulted.
Who gets PMS more ?
PMS is most common in women of reproductive age, who have regular menstrual periods. It can also be encountered very rarely in the menopausal period.
Is it possible to get pregnant during PMS ?
There is no relationship between PMS and being pregnant. The cycle of every woman who has regular menstruation consists of 4 weeks. The beginning of the cycle is taken as the first day of menstrual bleeding. So, days 10 to 18 of the cycle are the days when ovulation is most common and are most suitable for conception. PMS, on the other hand, corresponds to approximately the 4th week. In this case, although the probability is partially low, it is possible to get pregnant in the presence of unprotected intercourse. It is possible to get pregnant at every stage of the cycle, including menstrual bleeding.
How to get over the PMS period ?
In mild and moderate cases, it may be sufficient to regulate the lifestyle and habits.
-Restrict consumption of sugar, salt, coffee, alcohol and cigarettes
-Taking vitamin and mineral supplements,
-To provide sleep patterns, to go to bed at the same times every night and to sleep at least 8 hours of quality sleep,
-Doing sports regularly, taking up hobbies and participating in social activities to reduce stress,
-Eating a balanced diet to help relieve edema
Initiating birth control pills to reduce hormonal changes when needed helps to pass the PMS period more comfortably.