Is it premenstrual syndrome (PMS)?
There are no specific findings on physical examination, laboratory tests, or imaging techniques that can help in the diagnosis of premenstrual syndrome (PMS). Diagnosis is done by elimination of other likely causes, which may be aided by a physical examination, including a pelvic examination and a psychiatric evaluation, where deemed necessary.
A thorough clinical history often points to the diagnosis of PMS. The criteria for diagnosis of PMS includes :
- Symptoms of edema, weight gain, irritability, restlessness, and increased tension.
- Symptoms must occur in the second half of the menstrual cycle.
- There should be at least 7 symptom-free days in the first half of the cycle. This is considered to be the most important diagnostic point for PMS.
- The symptoms must occur in 3 consecutive menstrual cycles.
- The symptoms must be severe enough to require medical attention – advice or treatment.
Read more on premenstrual symptoms.
A psychiatric history is important, which should include a personal history of psychiatric problems and a family history of affective disorders. A mental status evaluation should also be done.
Symptom Calendar or Diary
Maintaining a symptom calendar or a menstrual diary, which records physical as well as emotional symptoms over a period of at least 3 months, is helpful in confirming the diagnosis by identifying the typical symptom pattern of PMS.
With PMS, there will be an exacerbation of symptoms before menstruation, which will be relieved once the period starts, and there will be at least one symptom-free week afterwards. There are many conditions that may mimic PMS and a menstrual diary can help to exclude these conditions.
Psychiatric disorders, which tend to worsen premenstrually, and menstrual disorders may also be identified by a symptom calendar.
Conditions That May Mimic PMS
This may include :
- Anxiety disorders
- Chronic fatigue syndrome (CFS)
- Idiopathic edema (cyclic water retention)
- Thyroid disorders
- Irritable bowel syndrome (IBS)
- Perimenopause – the transition period in a woman’s life as she approaches menopause
Treatment of Premenstrual Syndrome (PMS)
Since the exact cause of PMS is not known, treatment is controversial. There are many therapeutic recommendations and what works for one woman may not work for another. General measures such as acknowledging the problem, sympathy, and reassurance from people at home and in the workplace can go a long way in helping to cope with the condition.
Dietary measures and medical treatment is effective in most women with more severe PMS symptoms, but long term treatment is necessary as the symptoms tend to recur on stopping treatment. Most PMS symptoms worsen with age and only cease completely after menopause.
Diet and Lifestyle
Health measures that may be helpful include :
- a healthy diet with reduced salt intake
- reduced alcohol intake
- quitting smoking
Medication that may help with the PMS symptoms include :
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen which may be used for relief from symptoms such as headache, cramps, and breast tenderness.
- Diuretics which are drugs to eliminate excess body fluid by increasing urine output but are only recommended in case of severe fluid retention causing excessive bloating, breast pain, and weight gain.
- Combined contraceptive pills, containing both estrogen and progesterone, may help some women by suppressing ovulation.
- Suppression of ovulation by drugs such as danazol and gonadotropin-releasing hormone (GnRH) analogueshelp some women but cannot be used over long periods of time because of undesirable side effects.
- Symptoms of breast pain are especially helped by danazol, bromocriptine, and tamoxifen.
- Antidepressants, particularly selective serotonin-reuptake inhibitors (SSRIs), may be helpful in severe cases. Alternately, cognitive behavioral therapy (CBT) may be considered.
- Anxiolytics (anti-anxiety drugs) may be used in patients with severe anxiety.
- Alternative therapies, including herbal therapy and nutritional supplements of vitamin B6, vitamin E, calcium, and magnesium are sometimes reported to be of benefit. However, there is a lack of clinical evidence verifying the efficacy of these measures.
- Relaxation techniques such as Tai chi, yoga and meditation may also help to manage stress and cope with the symptoms.