Signs and Symptoms of Premenstrual Syndrome

Premenstrual Syndrome presents with a range of both physical and psychological symptoms, detailed below:

Psychological Symptoms: These encompass the emotional and mental aspects affected by PMS, such as moodiness, feelings of sadness, stress, worry, tiredness, and trouble concentrating.

• Irritability: Increased feelings of frustration, easily becoming annoyed, and general mood swings.

• Depression: Persistent low mood, feelings of despair, and a sense of hopelessness.

• Tension: Elevated levels of stress and an increased emotional reactivity to situations.

• Anxiety: Feelings of worry, nervousness, or a sense of unease or apprehension.

• Fatigue: A general feeling of being worn out, lacking energy, and feeling weak.

• Difficulty Concentrating: Problems focusing, reduced attention span, and a sensation of mental cloudiness.

Physical Symptoms: These are the bodily manifestations of PMS, including abdominal swelling, a feeling of weight gain, breast tenderness, skin breakouts, headaches, and severe migraines.

• Abdominal Bloating: Feeling swollen or having a sensation of fullness in the stomach area.

• Feeling of Weight Gain: A subjective sense of increased body weight, often related to water retention.

• Breast Swelling and Tenderness: Breasts feeling sore, sensitive to touch, and possibly enlarged due to hormonal shifts.

• Acne: Outbreaks of pimples or worsening of existing acne, and increased skin oiliness.

• Headache: Pain in the head of varying intensity.

  • Migraine: Severe, often debilitating headaches, sometimes accompanied by nausea and increased sensitivity to light and sound.

Management of Premenstrual Syndrome (PMS)

PMS is considered clinically significant when symptoms routinely interfere with daily living activities. Management strategies can be broadly categorized into non-pharmacological and pharmacological approaches.

Non-pharmacological Strategies

• Dietary Adjustments:

  • Increase Intake: Focus on boosting consumption of Vitamin B6, complex carbohydrates, fruits, and vegetables, such as whole grains and legumes.

  • Avoid Caffeine: Reduce or eliminate caffeine intake.

  • Limit Harmful Substances: Quit smoking and minimize alcohol consumption.

  • Reduce Salt: Lower overall salt intake in the diet.

  • Dietary Education: Inform patients about the benefits of diets rich in omega-3 fatty acids and lower in saturated fats.

  • Fruit and Vegetable Emphasis: Encourage a higher proportion of fruits and vegetables in daily meals.

• Physical Exercise:

  • Regular Activity: Promote consistent engagement in physical exercise, including activities like aerobic workouts and regular walking.

  • Symptom Relief Exercises: Recommend specific exercises that can help alleviate bloating, reduce irritability, and improve sleep issues.

• Education and Counseling:

  • PMS Education: Provide comprehensive information regarding the causes, available treatments, and preventative measures for PMS.

  • Emotional Support: Offer counseling services to address the emotional challenges of PMS and develop effective coping strategies.

• Stress Management:

  • Relaxation Techniques: Teach and encourage the use of relaxation methods and visualization techniques to manage stress levels.

• General Lifestyle Measures:

  • Patient Education: Ensure the patient is well-informed about PMS as a condition.

  • Exercise Promotion: Advocate for regular exercise to manage common PMS symptoms like bloating, moodiness, and insomnia.

  • Dietary Recommendations: Advise a diet abundant in complex carbohydrates, calcium, omega-3s, and low in saturated fats.

  • Caffeine Reduction: Suggest minimizing caffeine to help lessen breast tenderness and irritability.

  • Limit Unhealthy Substances: Reduce intake of sugar, alcohol, and excessive salt.

  • Salt Restriction: Specifically limit salt to help decrease abdominal bloating and fluid retention.

  • Fruit and Vegetable Focus: Emphasize the importance of including plenty of fruits and vegetables.

  • Smoking Cessation: Advise patients who smoke to quit for overall health and potential PMS symptom improvement.

Pharmacological Strategies

• Combined Oral Contraceptives (COCs): Utilize hormonal birth control pills to help stabilize hormonal fluctuations throughout the menstrual cycle.

• Antidepressants:

  • SSRIs Consideration: For PMS with significant depressive and anxious symptoms, consider Selective Serotonin Reuptake Inhibitors (SSRIs) such as fluoxetine (20 mg daily) or paroxetine (20 mg daily).

  • Timing of SSRI Use: Start SSRIs around ovulation time and discontinue on the first day of menstruation.

  • Side Effect Monitoring: Closely watch for potential side effects from SSRIs, including sleep disturbances, fatigue, and decreased sexual desire.

• Diuretics:

  • Diuretic Recommendation: For patients experiencing significant fluid retention and weight gain, diuretics like furosemide (20-40 mg) may be suggested.

  • Spironolactone Use: Spironolactone (50-100 mg daily for 7 days) can be beneficial in reducing fluid retention symptoms.

• Vitamins and Supplements:

  • Vitamin Supplementation: Consider Vitamin B6 (50-100 mg daily) and calcium supplements (600 mg twice daily) to help reduce physical symptoms associated with PMS.