PMS (premenstrual syndrome): symptoms, causes, therapy

Premenstrual Syndrome (PMS): symptoms, causes, therapy

Premenstrual Syndrome (PMS) refers to physical symptoms such as lower abdominal pain (4) and/or psychological impairments (8) up to depressive moods (2) that occur before the start of menstrual bleeding (3). It does not exist in men, only in females (1). The reasons for this are not yet fully understood. However, female hormones (7) seem to play a central role (6). There are several treatments available (5). Here you can read everything you need to know about Premenstrual Syndrome (PMS): symptoms, causes, and risk factors, treatment, and prognosis.

premenstrual syndrome, PMS (premenstrual syndrome): symptoms, causes, therapy

Brief overview

  • What is Premenstrual Syndrome (PMS)? Premenstrual Syndrome (PMS) is the abbreviation for premenstrual syndrome. It occurs about two weeks to a few days before menstruation starts and is associated with physical and/or psychological symptoms. With the onset of menstruation the complaints disappear again. About 80 percent of women of childbearing age are affected by Premenstrual Syndrome (PMS).
  • Symptoms: physical complaints such as lower abdominal pain, nausea, headaches. Psychological symptoms like sadness, mood swings, depressive moods. The symptoms vary from woman to woman and from cycle to cycle.
  • Causes: Not fully clarified. Probably cycle-related fluctuations in the blood levels of female hormones (estrogen, progesterone) play a central role.
  • Risk factors: stress, partnership problems, unbalanced diet, family history
  • Treatment: sufficient sleep and exercise, balanced diet, relaxation and meditation exercises, hot water bottles, and hot teas. In severe cases, medication (painkillers, possibly antidepressants, draining agents). Medicinal plants and homeopathy often have a supportive effect.
  • Prognosis: Premenstrual Syndrome (PMS) is not a disease in the classical sense and therefore cannot be “cured” by medical treatment. After the menopause, the symptoms usually disappear.

Symptoms Of Premenstrual Syndrome

Premenstrual Syndrome (PMS) affects about 80 percent of all women of childbearing age. You will have various physical and/or psychological complaints two weeks to three days before the start of your period, which will disappear again when your period begins. The nature and extent of the symptoms vary from woman to woman. They may also vary from month to month.

 Possible physical Premenstrual Syndrome (PMS) symptoms include

  • Abdominal pain
  • Feeling of pressure in the lower abdomen
  • Diarrhea or constipation
  • Circulatory problems, dizziness
  • Hot flushes, sweating
  • Back pain
  • impure skin, pimples

In addition, appetite can be altered by Premenstrual Syndrome (PMS): Some women suffer from ravenous appetite attacks, while others complain of loss of appetite and a feeling of fullness. Nausea before the period and an inflated stomach are also possible. Some women also report weight gain before their period. This is not so much due to an increased food intake as to a storage of water in the tissue.

Breast tenderness and chest pain before menstruation are also possible signs of Premenstrual Syndrome (PMS). Doctors refer to this as mastodynia. Puncturing or pulling pain is characteristic. Often the breast is also enlarged because the hormonal imbalance before the period causes water to be stored in the breast tissue. With the beginning of menstrual bleeding, these water accumulations (edemas) recede again.

Mastalgia is to be distinguished from mastodynia. This is chest pain independent of menstruation (i.e. independent of the menstrual cycle). They can be caused by cysts, breast inflammation, or breast cancer.

Headaches before the period are also not uncommon in Premenstrual Syndrome (PMS). Many women suffer from pressure pains in the middle of the head before menstruation. In some patients, the headache develops into a migraine. In general, women can react much more sensitively to stimuli such as bright light, noise smells, or touch before menstruation, which is then often perceived as extremely unpleasant. In addition, Premenstrual Syndrome (PMS) sufferers are less able to cope with time pressure or stress during this time.

Mental Premenstrual Syndrome (PMS) symptoms

Premenstrual Syndrome (PMS) is usually accompanied not only by physical but also psychological symptoms. For example, affected women are often irritable in the period before menstruation. They also get tired faster, need more breaks, and more sleep than usual. Other psychological Premenstrual Syndrome (PMS) symptoms that are frequently observed are

  • sudden fits of rage
  • depressive moods
  • greater anxiety
  • Lack of interest
  • Loss of mental drive
  • inner anxiety
  • Concentration disorders
  • Insomnia
  • Hyperactivity

Many women also feel overstrained more quickly in the period before their period. They worry more and feel a loss of control. Many are also sad or depressed. Often this also affects self-esteem. This reinforces the overall negative sensation, which in turn can increase other Premenstrual Syndrome (PMS) symptoms such as anxiety, concentration, and sleep disturbances. Thus the affected women often get into a cycle of negative emotions.

The sadness or depressive mood before the period often has no objective reason. It can also disappear again suddenly. These inexplicable mood swings often lead to problems with the partner, family, or friends.

If you suffer from mental Premenstrual Syndrome (PMS) symptoms, it does not mean that you are mentally ill. The psychological changes – just like the physical ones – are caused, among other things, by the changed hormone level. Just like the physical symptoms of Premenstrual Syndrome (PMS), the psychological symptoms disappear one or two days before menstruation.

Many women suffer from this condition, but the symptoms can vary from woman to woman.

Premenstrual Syndrome (PMS) or pregnancy?

Some Premenstrual Syndrome (PMS) symptoms, such as mood swings, abdominal pain, nausea, and ravenous appetite attacks, may also indicate pregnancy. However, especially at the beginning of a pregnancy, there are other complaints that can be clearly distinguished from Premenstrual Syndrome (PMS). These include morning sickness, a permanently slightly elevated temperature, and extreme exhaustion. And at the latest when the next menstrual bleeding fails to occur, the question is clarified: Premenstrual Syndrome (PMS) or pregnancy?

Premenstrual Dysphoric Disorder (PMDS)

In about five percent of Premenstrual Syndrome (PMS) sufferers, the burden of premenstrual syndrome is so great that the normal daily routine, work, and family life are affected. These particularly severe cases are known as premenstrual dysphoric disorder (PMDS). In contrast to Premenstrual Syndrome (PMS), it is considered a disease.

Premenstrual Syndrome (PMS) is the term used to describe complaints such as mood swings, breast tenderness, or a feeling of fullness (bloated abdomen), which occur exclusively before the onset of menstruation and disappear again when bleeding begins. They are therefore clearly associated with menstruation.

The consumption of chocolate increases sugar and insulin levels. This indirectly leads to a “better feeling”, but does not change the actual Premenstrual Syndrome (PMS). As a preventive measure, you can try to eat a balanced diet, get enough sleep, and exercise. Sometimes monk’s pepper or Chaste tree (Agnus castus) also relieves the occurrence of the symptoms.

If the symptoms persist in spite of the above tips, a hormonal disorder could also be the reason. Thyroid dysfunction or an increase in the hormone prolactin sometimes leads – as does the beginning of the menopause – to a weakness of the corpus luteum, which triggers Premenstrual Syndrome (PMS). If you suspect that this could be the case with you, have your hormone levels checked.

Causes And Risk Factors Of Premenstrual Syndrome (PMS)

The causes of Premenstrual Syndrome (PMS) have not yet been clearly clarified. Doctors suspect that several factors trigger the symptoms. This is called a multifactorial origin or multifactorial genesis.

The role of hormones

Hormones appear to be the main cause of Premenstrual Syndrome (PMS). These are endogenous messenger substances that transmit messages between different organs and/or the brain. The female sex hormones estrogen and progesterone are particularly relevant for menstruation. Together with other female hormones, they ensure in each cycle that an egg matures, ovulation (release of the egg from the ovary) occurs and the uterine lining is prepared for the implantation of a fertilized egg. If fertilization does not occur, the egg, including the prepared uterine lining, is rejected during menstruation.

During ovulation the estrogen concentration in the blood is highest. Many women feel the ovulation by a painful pulling in the lower abdomen. In addition, more prolactin is produced during this time. This hormone makes the mammary glands swell, which sometimes leads to tension pains in the breasts.

The hormonal changes during the cycle can also cause electrolyte and fluid shifts in the body. This could be responsible for at least some of the symptoms. The substances that are produced when the hormone progesterone is broken down are also suspected of triggering symptoms. In addition, sufferers of this condition may be more sensitive to the interaction between progesterone and certain messenger substances in the brain such as serotonin.

Other possible causes

Other factors that could contribute to the development of premenstrual syndrome are

  • low melatonin level
  • Hypothyroidism (hypothyroidism)
  • Vegetative nervous system disorders
  • Stress
  • Problems in the partnership
  • unbalanced diet
  • Nicotine consumption
  • little movement
  • some hormonal contraceptives

In addition, a family history of mental illness (for example depression) is considered a risk factor for the premenstrual dysphoric syndrome (PMDS).

Diagnosis And Examinations For Premenstrual Syndrome (PMS)

If you suspect this condition, you should discuss this with your gynecologist. The doctor will first ask you about your medical history (anamnesis). Describe your complaints as precisely as possible (preferably taking notes and reading them to the doctor) so that he can form an exact picture in his mind. You should prepare yourself for these questions:

  • How long before menstruation do the symptoms first appear?
  • Are you in pain and if so, where exactly?
  • Do the symptoms always occur before the start of your period?
  • Do you only have physical complaints or do you also feel mentally impaired?

A  set of notes can help you prepare for this, in which you note down over several cycles when which symptoms occur. This will allow you to give your doctor accurate information. This helps him to rule out other causes of your complaints.

The medical history is followed by a physical examination. With gynecological palpation and an ultrasound examination of the uterus and neighboring organs, the doctor can exclude organic diseases such as a tumor as the cause of the complaints. In addition, the physician (possibly together with other specialists) will examine whether the symptoms are possibly caused by hypothyroidism, endometriosis, or depression. The onset of menopause must also be excluded, as Premenstrual Syndrome (PMS)-like symptoms can also occur during this period.

A blood test can provide additional information. The expert can tell from various blood values whether your symptoms are due to hormonal causes. In general, women with the symptoms of this condition show increased levels of inflammation during the symptoms.

Treatment For Premenstrual Syndrome (PMS)

Premenstrual Syndrome (PMS) treatment depends on how intense the symptoms are. In mild cases it usually helps if you get enough sleep and exercise regularly. A balanced diet is also recommended: make sure you eat a diet rich in carbohydrates, low in salt, and easily digestible. Avoid coffee, alcohol, and nicotine because they can increase the symptoms. You can relieve lower abdominal pain with a hot water bottle or hot tea. Many women also benefit from specific relaxation exercises or meditation.

In severe cases, however, when the complaints affect everyday life, such symptomatic therapy is not sufficient. Then the Premenstrual Syndrome (PMS) should be treated with medication. Painkillers such as ibuprofen, hormone preparations, and mood-lifting drugs (antidepressants) are available for this purpose. Massive water retention (edema) can be treated with diuretic drugs. Psychiatric treatment can be useful for severe psychological symptoms.

Sometimes dietary supplements, for example with magnesium or iron, can also alleviate the symptoms. Discuss the use of such preparations with your doctor.

Premenstrual Syndrome (PMS): homeopathy and medicinal plants

Many women rely on complementary cures for this condition. Even though their effectiveness is often not scientifically proven, many sufferers nevertheless report an improvement in their symptoms.

Homeopathy knows several remedies that can be used for this condition. Depending on the type of complaints, these include, for example, Calcium carbonicum (water retention, especially with swollen breasts), Pulsatilla (sadness with frequent crying), Natrium muriaticum (irritability, sensitivity, crying) and Cyclamen (painful swollen breasts, migraine-like headaches, etc.). Women can seek advice from an experienced therapist on the selection of suitable homeopathic remedies.

Herbal medicine can also help with the symptoms. For example, the effectiveness of herbal preparations containing monk’s pepper has been scientifically well researched. Such preparations are used, for example, when an increased prolactin level causes pain and tension in the breasts. Preparations with St. John’s wort are helpful for mild depressive moods. Valerian and lemon balm are recommended against sleeping problems and nervous restlessness. A doctor or pharmacist can recommend suitable medicinal plants to women for their symptoms and give advice on how to use them.

Prognosis Of The Premenstrual Syndrome (PMS)

An exact prognosis for this condition is not possible. This is because it is not an acute disease that can be completely cured with therapy. But at the latest with the menopause, the symptoms of this condition generally disappear completely. Until then, the symptoms can usually be controlled with relaxation, sufficient sleep and exercise, and a balanced diet.

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Sandra Eades
Hello I am Sandra Eades, physician, researcher and author from Australia. I am working currently as researcher for a private institution. I have studied in Britain and Australia, where I currently reside. I write about research topics in the organization of the public health government agencies. For the iMS I write about general medical conditions. I also research scholar sources to provide information to writers of other articles. I also check the citations of scholar papers. Finally, I read other articles before they are published. I am also a mother of three children!