As menstrual bleeding approaches, some complaints appear in 75% of women due to changing hormone levels. In half of these women the complaints are mild and do not affect the person’s daily life. In the other half, much more serious complaints appear, including depression. Premenstrual complaints can be physical or psychological and can be affected by cultural differences. PMS is the combination of both physical and psychological events. Studies show that different complaints appear in women coming from different cultures. While the most frequently encountered complaint in Far Eastern women is pain, in developed Western societies depression is the most frequently encountered finding. Complaints that affect a person’s social life negatively and that are seen every month can even cause a woman to lose her self-confidence.
Physical symptoms
In almost all women who show signs of PMS, tenderness in the breasts and a slight temporary weight gain are found. Other symptoms can be listed as disorders of the digestive system, headache, rashes, muscle and joint pains, weakness, bleeding gums, palpitations, balance disorders, hot flushes, excessive sensitivity to sounds and smells, agitation and sleeplessness. Menstrual bleeding being painful or heavy, that is, dysmenorrhoea, is not assessed as PMS.
Emotional symptoms
Emotional hypersensitivity is very often seen in PMS. There can be many different mood states, from depression to anxiety and excessive irritability. In some women mild memory loss may be seen. Difficulty concentrating is not an uncommon situation in PMS. The state of depression, restlessness and tension seen in some women is called premenstrual dysphoric disorder (PMDD).
Causes
The studies aimed at finding the causes of PMS have not been able to reveal fully the factors underlying this picture. However, there are some theories. When certain hormones that suppress ovulation are given, there is a regression in the symptoms of PMS. According to this, reproductive hormones may cause PMS, but what this role is has not been explained. There is strong evidence that PMS arises as a result of these hormones acting together with certain substances that provide transmission in the nerves. The substances most often blamed are those called GABA and serotonin. Some researchers, on the other hand, believe that a disturbance in the calcium and magnesium balance gives rise to the picture of PMS. The distribution of these two minerals in the body may cause the picture by affecting communication between nerve cells. These researchers suggest that in women with PMS a magnesium deficiency or an excess of calcium creates the complaints. Another cause put forward in the aetiology of PMS is stress hormones. An excess of these hormones may cause the complaints to be experienced more intensely. In the aetiology of PMS almost all hormones and substances secreted in the body are blamed. However, no proven cause has been found.
In whom is it seen
PMS is a condition encountered in all cultures throughout the world. In one study, signs of PMS at varying levels were found in 88% of women. As age increases the severity of the complaints decreases, but the severity increases along with the number of children. Complaints are also encountered more frequently in women whose mother has PMS. PMS can also increase the severity of some illnesses. For example, in women who have migraine, a large part of the attacks fall in the premenstrual period. Likewise, in diabetic patients, blood sugar levels and insulin needs show changes in the premenstrual period. Asthma attacks are seen more frequently and many chronic illnesses show flare-ups. In this period the person’s harmony with those around them is disturbed and their relations with the people they deal with at work or at home and with their children may deteriorate. In young girls in adolescence the tendency towards suicide may increase. Eating disorders may be encountered.
Diagnosis
The diagnosis of PMS is not based on positive findings. The most reliable way for the diagnosis is to record the complaints for 2 to 3 months and to score their severity. The complaints should be separated into physical and mental ones, and when they begin and when they end should be recorded in a regular way.
Treatment
Because the cause of PMS is not known exactly, its treatment is also not definite. There are many different treatment approaches on this subject. Diet: There are reports that eating little and often reduces the complaints. In the premenstrual period, consuming fresh fruit and vegetables, staying away from red meat and solid fats, and not consuming foods containing additives can sometimes be useful. In the same way, reducing the consumption of caffeine and alcohol can also be useful. Exercise: in one study it was found that PMS is encountered more frequently in women who do not exercise. A 30-minute walk taken every day can be useful. Calcium and magnesium: There is a study reporting that taking 1200 mg of calcium daily halves the complaints at the end of 3 months. In some women benefit has been obtained from magnesium supplementation. However, there are as yet no definite findings on this subject. Vitamins: Although it has been suggested that vitamins A, E and B6 cause PMS, there is no definitively proven finding. Among the other treatment options can be listed medicines related to serotonin metabolism, hormone medicines, psychiatric medicines such as antidepressants and anti-anxiety drugs, diuretics and male hormones, but none of these has a proven benefit. Among the other rare treatment approaches are psychotherapy and acupuncture.