Premenstrual Syndrome: Difference between revisions
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== Definition == | == Definition == | ||
Premenstrual Syndrome (PMS) is a combination of physical, psychological/emotional, or behavioral symptoms that start one or two weeks before the beginning of [[Menstruation and Menstrual Rehab|menstruation]] after the ovulation period. The severity range from mild to severe that may hinder their work and [[ADLs|ADL activities.]] And they start to resolve with the beginning of the menstruation as the levels of the hormones start to return to their levels. PMS symptoms may change throughout your life in severity and complain, [[depression]], stress, or history with postpartum depression are all contributing factors that may worsen your symptoms. PMS may get worse when women approach menopause especially at the end of their 30s or 40s and stop after [[menopause]]. If the woman has a history of seizure disorders, migraines, asthma, or allergies they will get worse during the PMS period. PMS represents about 75% of women of reproductive age, and severe symptoms find in about 5–8% of women. | Premenstrual Syndrome (PMS) is a combination of physical, psychological/emotional, or behavioral symptoms that start one or two weeks before the beginning of [[Menstruation and Menstrual Rehab|menstruation]] after the ovulation period. The severity range from mild to severe that may hinder their work and [[ADLs|ADL activities.]] And they start to resolve with the beginning of the menstruation as the levels of the hormones start to return to their levels. PMS symptoms may change throughout your life in severity and complain, [[depression]], stress, or history with postpartum depression are all contributing factors that may worsen your symptoms. PMS may get worse when women approach menopause especially at the end of their 30s or 40s and stop after [[menopause]]. If the woman has a history of seizure disorders, migraines, asthma, or allergies they will get worse during the PMS period. PMS represents about 75% of women of reproductive age, and severe symptoms find in about 5–8% of women. There is increase risk of suicide with PMS and PMDD compared with women without premenstrual disturbances<ref>Prasad D, Wollenhaupt-Aguiar B, Kidd KN, de Azevedo Cardoso T, Frey BN. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8721500/ Suicidal risk in women with premenstrual syndrome and premenstrual dysphoric disorder: a systematic review and meta-analysis]. Journal of Women's Health. 2021 Dec 1;30(12):1693-707.</ref>. | ||
Premenstrual dysphoric disorder (PMDD) is similar to PMS but characterized by sever irritability, depression, and anxiety and affects 3–8% of menstruating women<ref>Gao M, Gao D, Sun H, Cheng X, An L, Qiao M. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096922/ Trends in Research Related to Premenstrual Syndrome and Premenstrual Dysphoric Disorder] From 1945 to 2018: A Bibliometric Analysis. Frontiers in Public Health. 2021 Apr 21;9:380.</ref>. | Premenstrual dysphoric disorder (PMDD) is similar to PMS but characterized by sever irritability, depression, and anxiety and affects 3–8% of menstruating women<ref>Gao M, Gao D, Sun H, Cheng X, An L, Qiao M. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096922/ Trends in Research Related to Premenstrual Syndrome and Premenstrual Dysphoric Disorder] From 1945 to 2018: A Bibliometric Analysis. Frontiers in Public Health. 2021 Apr 21;9:380.</ref>. | ||
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==== Medical management ==== | ==== Medical management ==== | ||
'''Selective serotonin reuptake inhibitors (SSRIs)''' is the first pharmacological line recommended by RCOG guidelines for sever PMS, it was effective to treat moderate and sever symptoms of PMS, and should be discontinued gradually to avoid withdrawal symptoms if given on a continuous. | '''Selective serotonin reuptake inhibitors (SSRIs)''' is the first pharmacological line recommended by RCOG guidelines for sever PMS, it was effective to treat moderate and sever symptoms of PMS, and should be discontinued gradually to avoid withdrawal symptoms if given on a continuous<ref name=":2">Sammon CJ, Nazareth I, Petersen I. Recording and treatment of premenstrual syndrome in UK general practice: a retrospective cohort study. BMJ open. 2016 Mar 1;6(3):e010244.</ref>. | ||
'''Combined oral contraceptive pills (COC)''' | '''Combined oral contraceptive pills (COC)'''<ref name=":2" />'''.''' | ||
[[File:Vitex agnus-castus.jpg|thumb|Vitex agnus-castus]] | [[File:Vitex agnus-castus.jpg|thumb|Vitex agnus-castus]] | ||
'''GnRH analogues''' is effective in treatment of PMDD and could not be used for a long period it may cause genital atrophy and bone loss because of estrogen deficiency. Used when SSRI and COC failed to treat symptoms. | '''GnRH analogues''' is effective in treatment of PMDD and could not be used for a long period it may cause genital atrophy and bone loss because of estrogen deficiency. Used when SSRI and COC failed to treat symptoms. | ||
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'''Vitex''', is safe to use and it was superior to placebo, however, further research about Vertix is still needed<ref name=":1" />. | '''Vitex''', is safe to use and it was superior to placebo, however, further research about Vertix is still needed<ref name=":1" />. | ||
'''Antidepressant'''. | |||
'''NSAID.''' | |||
=== Cognitive Behavioral Therapy === | === Cognitive Behavioral Therapy === | ||
RCOG guidelines stated that "''When treating women with severe PMS, CBT should be considered routinely as a treatment'' | RCOG guidelines stated that "''When treating women with severe PMS, CBT should be considered routinely as a treatment'' | ||
''option" level of evidence A.'' CBT help women to control and manage their symptoms can be useful for some women, and it's effect will maintain for a period of time<ref>Hofmeister S, Bodden S. Premenstrual syndrome and premenstrual dysphoric disorder. American family physician. 2016 Aug 1;94(3):236-40.</ref>. | ''option" level of evidence A.'' CBT help women to control and manage their symptoms can be useful for some women, and it's effect will maintain for a period of time<ref>Hofmeister S, Bodden S. Premenstrual syndrome and premenstrual dysphoric disorder. American family physician. 2016 Aug 1;94(3):236-40.</ref><ref>Ussher JM, Perz J. Evaluation of the relative efficacy of a couple cognitive-behaviour therapy (CBT) for Premenstrual Disorders (PMDs), in comparison to one-to-one CBT and a wait list control: A randomized controlled trial. PloS one. 2017 Apr 18;12(4):e0175068.</ref>. | ||
==== Physical Therapy Management ==== | ==== Physical Therapy Management ==== | ||
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Exercises is the first line treatment for PMS, repeated muscle contraction during physical exercises prevent accumulation of PG and other substances so reduces back and abdominal pain, exercise has a positive effect on emotional conditions and to manage stress. | Exercises is the first line treatment for PMS, repeated muscle contraction during physical exercises prevent accumulation of PG and other substances so reduces back and abdominal pain, exercise has a positive effect on emotional conditions and to manage stress. | ||
Aerobic exercises for example increase RBC, decrease the levels of progesterone and estradiol, increase beta endorphin level and increase pain tolerance, resulting in improvement of concentration, fatigue, and majority of PMS symptoms<ref>Dehnavi ZM, Jafarnejad F, Goghary SS. [https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0565-5 The effect of 8 weeks aerobic exercise on severity of physical symptoms of premenstrual syndrome]: a clinical trial study. BMC women's health. 2018 Dec;18(1):1-7.</ref><ref>Maged AM, Abbassy AH, Sakr HR, Elsawah H, Wagih H, Ogila AI, Kotb A. [https://link.springer.com/article/10.1007%2Fs00404-018-4664-1#Sec5 Effect of swimming exercise on premenstrual syndrome]. Archives of gynecology and obstetrics. 2018 Apr;297(4):951-9.</ref>. | ''Aerobic exercises'' for example increase RBC, decrease the levels of progesterone and estradiol, increase beta endorphin level and increase pain tolerance, resulting in improvement of concentration, fatigue, and majority of PMS symptoms<ref>Dehnavi ZM, Jafarnejad F, Goghary SS. [https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0565-5 The effect of 8 weeks aerobic exercise on severity of physical symptoms of premenstrual syndrome]: a clinical trial study. BMC women's health. 2018 Dec;18(1):1-7.</ref><ref>Maged AM, Abbassy AH, Sakr HR, Elsawah H, Wagih H, Ogila AI, Kotb A. [https://link.springer.com/article/10.1007%2Fs00404-018-4664-1#Sec5 Effect of swimming exercise on premenstrual syndrome]. Archives of gynecology and obstetrics. 2018 Apr;297(4):951-9.</ref>. | ||
''[[Yoga]]'' demonstrated strong effect on depression symptoms and can be used as a complementary treatment for PMS management<ref>Ghaffarilaleh G, Ghaffarilaleh V, Sanamno Z, Kamalifard M. Yoga positively affected depression and blood pressure in women with premenstrual syndrome in a randomized controlled clinical trial. Complementary therapies in clinical practice. 2019 Feb 1;34:87-92.</ref> to reduce physical and emotional symptoms associated with PMS<ref>Wu WL, Lin TY, Chu IH, Liang JM. The acute effects of yoga on cognitive measures for women with premenstrual syndrome. The Journal of Alternative and Complementary Medicine. 2015 Jun 1;21(6):364-9.</ref> it reduces body aches, breast tenderness,and abdominal cramps. | |||
Yoga reduces stress, the inflammatory mediators, and regulate levels of IgA so has a positive effect on the immune system. In a another study when Yoga was performed for 10 weeks, 3 sessions per week, 60 min for each session this was associated with improvements in sleeping disturbance<ref>Ghaffarilaleh G, Ghaffarilaleh V, Sanamno Z, Kamalifard M, Alibaf L. Effects of yoga on quality of sleep of women with premenstrual syndrome. Altern. Ther. Health Med. 2019 Sep 1;25:40-7..</ref> . | |||
== Differential Diagnosis<br> == | == Differential Diagnosis<br> == | ||
Revision as of 07:10, 21 January 2022
Definition[edit | edit source]
Premenstrual Syndrome (PMS) is a combination of physical, psychological/emotional, or behavioral symptoms that start one or two weeks before the beginning of menstruation after the ovulation period. The severity range from mild to severe that may hinder their work and ADL activities. And they start to resolve with the beginning of the menstruation as the levels of the hormones start to return to their levels. PMS symptoms may change throughout your life in severity and complain, depression, stress, or history with postpartum depression are all contributing factors that may worsen your symptoms. PMS may get worse when women approach menopause especially at the end of their 30s or 40s and stop after menopause. If the woman has a history of seizure disorders, migraines, asthma, or allergies they will get worse during the PMS period. PMS represents about 75% of women of reproductive age, and severe symptoms find in about 5–8% of women. There is increase risk of suicide with PMS and PMDD compared with women without premenstrual disturbances[1].
Premenstrual dysphoric disorder (PMDD) is similar to PMS but characterized by sever irritability, depression, and anxiety and affects 3–8% of menstruating women[2].
Cause of Premenstrual Syndrome[edit | edit source]
The definite cause for PMS is still not fully understood and may be multifactorial causes:
- The most suggested is fluctuation in hormones levels (ovarian hormones) during the menstruation cycle which in turn affects central neurotransmitters. There is evidence suggesting that a low level of circulating serotonin and enhanced progesterone sensitivity can explain PMS in some cases.
- Prostaglandin (PG) deficiency, PG has a role in forming prostaglandin precursors from linoleic acid[3].
- Genetic factors and depression may worsen the symptoms of PMS[4].
- The role of minerals and vitamins in etiology is still debatable and their role in treatment also[3].
Clinical Presentation[edit | edit source]
Physical symptoms:
- Abdominal bloating and cramping.
- Fatigue.
- Constipation
- Headache.
- Breast tenderness.
- Constipation or diarrhea.
- Change in appetite.
- Disturbance with sleeping ( sleeping more than usual or sleeping too little)
- Skin problems, acne.
- Gastrointestinal symptoms.
muscles and joint pain
Emotional symptoms:
- Depression.
- Anxiety.
- Anger.
- Oversensitivity.
- Mood swing.
- Crying spells
- Less interest in sex.
- Insomnia.
- Poor concentration.
Diagnostic Procedures[edit | edit source]
There is no definitive diagnostic test and the diagnosis of PMS depends on reporting to the symptoms for at least two or three months.
When rating the symptoms they must be present five days before the start of menstruation (during the luteal phase) for at least two cycles as recommended by RCOG, and these symptoms resolve within 4 days after the start of a period, these symptoms should:
- Negatively affect her ADLs and may cause some impairments.
- Exclude other diagnoses that may cause similar symptoms.
- One of the four physical symptoms (abdominal bloating, headache, breast tenderness, and swelling of extremities), and one of the following (angry spells, depression, anxiety, confusion, irritability and social withdrawal) according to American College of Obstetricians and Gynecologists[3].
She can use daily reporting severity scale to record her symptoms daily.
Outcome Measures[edit | edit source]
Premenstrual Tension Syndrome Observer (PMTS-O)
Premenstrual Tension Syndrome Self-Rating (PMTS-SR).
Management / Interventions
[edit | edit source]
Medical management[edit | edit source]
Selective serotonin reuptake inhibitors (SSRIs) is the first pharmacological line recommended by RCOG guidelines for sever PMS, it was effective to treat moderate and sever symptoms of PMS, and should be discontinued gradually to avoid withdrawal symptoms if given on a continuous[7].
Combined oral contraceptive pills (COC)[7].
GnRH analogues is effective in treatment of PMDD and could not be used for a long period it may cause genital atrophy and bone loss because of estrogen deficiency. Used when SSRI and COC failed to treat symptoms.
Diuretics (water pills) such as Spironolactone.
Vitex, is safe to use and it was superior to placebo, however, further research about Vertix is still needed[3].
Antidepressant.
NSAID.
Cognitive Behavioral Therapy[edit | edit source]
RCOG guidelines stated that "When treating women with severe PMS, CBT should be considered routinely as a treatment
option" level of evidence A. CBT help women to control and manage their symptoms can be useful for some women, and it's effect will maintain for a period of time[8][9].
Physical Therapy Management[edit | edit source]
Exercises is the first line treatment for PMS, repeated muscle contraction during physical exercises prevent accumulation of PG and other substances so reduces back and abdominal pain, exercise has a positive effect on emotional conditions and to manage stress.
Aerobic exercises for example increase RBC, decrease the levels of progesterone and estradiol, increase beta endorphin level and increase pain tolerance, resulting in improvement of concentration, fatigue, and majority of PMS symptoms[10][11].
Yoga demonstrated strong effect on depression symptoms and can be used as a complementary treatment for PMS management[12] to reduce physical and emotional symptoms associated with PMS[13] it reduces body aches, breast tenderness,and abdominal cramps.
Yoga reduces stress, the inflammatory mediators, and regulate levels of IgA so has a positive effect on the immune system. In a another study when Yoga was performed for 10 weeks, 3 sessions per week, 60 min for each session this was associated with improvements in sleeping disturbance[14] .
Differential Diagnosis
[edit | edit source]
Premenopause.
Resources[edit | edit source]
Management of Premenstrual Syndrome, RCOG Guidelines
References[edit | edit source]
- ↑ Prasad D, Wollenhaupt-Aguiar B, Kidd KN, de Azevedo Cardoso T, Frey BN. Suicidal risk in women with premenstrual syndrome and premenstrual dysphoric disorder: a systematic review and meta-analysis. Journal of Women's Health. 2021 Dec 1;30(12):1693-707.
- ↑ Gao M, Gao D, Sun H, Cheng X, An L, Qiao M. Trends in Research Related to Premenstrual Syndrome and Premenstrual Dysphoric Disorder From 1945 to 2018: A Bibliometric Analysis. Frontiers in Public Health. 2021 Apr 21;9:380.
- ↑ 3.0 3.1 3.2 3.3 Dilbaz B, Aksan A. Premenstrual syndrome, a common but underrated entity: review of the clinical literature. Journal of the Turkish German Gynecological Association. 2021 Jun;22(2):139.
- ↑ 4.0 4.1 Dickerson LM, Mazyck PJ, Hunter MH. Premenstrual syndrome. American family physician. 2003 Apr 15;67(8):1743-52.
- ↑ Reactions. What Causes PMS? . Available from: http://www.youtube.com/watch?v=W5BvYvyfarw[last accessed 14/1/2022]
- ↑ Steiner M, Streiner DL, Steinberg S, Stewart D, Carter D, Berger C, Reid R, Grover D. The measurement of premenstrual mood symptoms. Journal of affective disorders. 1999 Jun 1;53(3):269-73.
- ↑ 7.0 7.1 Sammon CJ, Nazareth I, Petersen I. Recording and treatment of premenstrual syndrome in UK general practice: a retrospective cohort study. BMJ open. 2016 Mar 1;6(3):e010244.
- ↑ Hofmeister S, Bodden S. Premenstrual syndrome and premenstrual dysphoric disorder. American family physician. 2016 Aug 1;94(3):236-40.
- ↑ Ussher JM, Perz J. Evaluation of the relative efficacy of a couple cognitive-behaviour therapy (CBT) for Premenstrual Disorders (PMDs), in comparison to one-to-one CBT and a wait list control: A randomized controlled trial. PloS one. 2017 Apr 18;12(4):e0175068.
- ↑ Dehnavi ZM, Jafarnejad F, Goghary SS. The effect of 8 weeks aerobic exercise on severity of physical symptoms of premenstrual syndrome: a clinical trial study. BMC women's health. 2018 Dec;18(1):1-7.
- ↑ Maged AM, Abbassy AH, Sakr HR, Elsawah H, Wagih H, Ogila AI, Kotb A. Effect of swimming exercise on premenstrual syndrome. Archives of gynecology and obstetrics. 2018 Apr;297(4):951-9.
- ↑ Ghaffarilaleh G, Ghaffarilaleh V, Sanamno Z, Kamalifard M. Yoga positively affected depression and blood pressure in women with premenstrual syndrome in a randomized controlled clinical trial. Complementary therapies in clinical practice. 2019 Feb 1;34:87-92.
- ↑ Wu WL, Lin TY, Chu IH, Liang JM. The acute effects of yoga on cognitive measures for women with premenstrual syndrome. The Journal of Alternative and Complementary Medicine. 2015 Jun 1;21(6):364-9.
- ↑ Ghaffarilaleh G, Ghaffarilaleh V, Sanamno Z, Kamalifard M, Alibaf L. Effects of yoga on quality of sleep of women with premenstrual syndrome. Altern. Ther. Health Med. 2019 Sep 1;25:40-7..
