Symptoms of Premenstrual Syndrome

Symptoms of Premenstrual Syndrome

Premenstrual syndrome (PMS) is a common condition that affects many women of reproductive age. It encompasses a broad range of physical, emotional, and behavioral symptoms that occur cyclically in relation to the menstrual cycle. These symptoms typically appear in the luteal phase—the period between ovulation and the start of menstruation—and can significantly impact the quality of life of those affected. Understanding the symptoms of premenstrual syndrome, both physical and mental, and their onset is crucial in managing PMS effectively.

Background: The Menstrual Cycle

To comprehend the symptoms of premenstrual syndrome, it’s essential first to understand the menstrual cycle, which consists of four phases: the menstrual phase, the follicular phase, ovulation, and the luteal phase.

1. Menstrual Phase: This is when menstruation occurs, typically lasting between 3-7 days. The body sheds the uterine lining if pregnancy has not occurred. Women experience bleeding and cramping (to varying degrees) along with many other physical symptoms such as fatigue and bloating.

2. Follicular Phase: Starting from the first day of menstruation until ovulation, the body prepares for the potential of pregnancy. Hormones like estrogen rise, leading to the thickening of the uterine lining. Women typically experience increased energy, clearer skin, better mood and greater sociability.

3. Ovulation: Occurring mid-cycle, an egg is released from the ovary, ready for fertilization. Women typically experience increased libido, increased confidence, positivity and a social attitude. Physically they may have mild pelvic pain with ovulation and clear, stretchy cervical mucus.

4. Luteal Phase: Following ovulation, the corpus luteum forms from the ruptured follicle, secreting progesterone to maintain the uterine lining. If fertilization does not occur, hormone levels drop, triggering the onset of PMS symptoms as the body prepares for menstruation.

The symptoms of premenstrual syndrome are most prominent during the luteal phase, typically emerging about one to two weeks before menstruation and usually subsiding with the onset of menstrual bleeding. The cyclic nature of these symptoms is a hallmark of PMS, distinguishing it from other conditions.

Physical Symptoms of PMS

PMS is known for a wide array of physical symptoms that can vary greatly in intensity and duration from one person to another. Some of the most common physical symptoms of premenstrual syndrome include:

1. Breast Tenderness: One of the earliest and most common symptoms of PMS is breast tenderness or swelling, which is due to the fluctuating levels of estrogen and progesterone. This can make the breasts feel heavy, sore, or swollen.

2. Bloating: Hormonal changes can cause the body to retain water and salt, leading to a feeling of bloating or abdominal discomfort. This symptom is often accompanied by weight gain.

3. Cramps (Dysmenorrhea): Abdominal cramps are common as the uterus contracts to shed its lining. These can range from mild discomfort to severe pain.

4. Headaches and Migraines: Some individuals experience headaches or migraines, likely due to hormonal fluctuations, particularly the drop in estrogen levels.

5. Fatigue: Increased tiredness or a feeling of sluggishness is a frequent complaint, even if the individual is getting adequate rest.

6. Changes in Appetite: Many people report cravings for specific foods, particularly those high in sugar or carbohydrates. Conversely, others may experience a loss of appetite. However, it is said that a typical women will burn about an extra 600 calories per day the week prior to menstruation.

7. Acne: The rise in androgens during the luteal phase can lead to an increase in sebum production, causing or worsening acne. This is often one of the first visible symptoms of premenstrual syndrome during a woman’s cycle.

8. Digestive Issues: Some individuals experience changes in bowel habits, such as constipation or diarrhea, which may be linked to the hormonal changes in the body.

What do Cramps Feel Like?

Menstrual cramps, also known as dysmenorrhea, typically manifest as a throbbing or cramping pain in the lower abdomen.

The best comparison maybe akin to a charley horse that cannot be soothed, since the muscle spasm is entirely internal and out of reach.

For some, the sensation can be a dull, persistent ache, while for others, it may feel like sharp, intense spasms. The pain can vary in intensity, ranging from mild discomfort to severe pain that can interfere with daily activities. The cramps often radiate to the lower back and thighs, creating a broader sense of discomfort. Some people also describe the sensation as a heavy, dragging feeling in the pelvic area, similar to a muscle strain or a knot that needs to be massaged out. Alongside the cramping, some individuals may experience nausea, headaches, or lightheadedness, further contributing to the overall discomfort.

Common Conditions that Worsen Menstrual Symptoms

Here are three medical conditions or medications that can worsen bleeding and other menstrual symptoms:

1. Endometriosis: This condition causes the tissue similar to the uterine lining to grow outside the uterus, leading to severe menstrual pain, heavy bleeding, and chronic pelvic pain.

2. Polycystic Ovary Syndrome (PCOS): PCOS can cause irregular, heavy, and painful periods due to hormonal imbalances. It often leads to prolonged menstrual cycles with more intense symptoms.

3. Anticoagulant Medications (e.g., Warfarin, Heparin): These medications, used to prevent blood clots, can increase menstrual bleeding, making periods heavier and longer than usual.

Mental Symptoms of PMS

In addition to the physical symptoms, PMS is also characterized by a range of mental and emotional symptoms. These symptoms can include:

1. Mood Swings: Rapid changes in mood are one of the most common mental symptoms of PMS. Individuals may find themselves feeling happy one moment and then inexplicably sad, angry, or irritable the next.

2. Irritability: Increased irritability is a frequent complaint during the luteal phase. Small annoyances that might typically be overlooked can become sources of significant frustration or conflict.

3. Depression and Sadness: Feelings of sadness, hopelessness, or even depression can emerge during PMS. These emotions can range from mild to severe and can affect an individual’s ability to function in daily life.

4. Anxiety: PMS can exacerbate feelings of anxiety, leading to increased worry or panic attacks in some individuals. This is particularly common in those who already experience anxiety outside of their menstrual cycle.

5. Cognitive Symptoms: Many individuals report difficulties with concentration, memory, or decision-making during the luteal phase. This is often referred to as “brain fog.”

6. Social Withdrawal: Due to the emotional and physical discomfort, some individuals may find themselves withdrawing from social activities, preferring to be alone.

7. Sleep Disturbances: Difficulty falling asleep, staying asleep, or experiencing restful sleep is common. Insomnia or excessive sleepiness can significantly impact daily functioning.

Severity of PMS Symptoms

The severity of PMS symptoms can vary widely among individuals. For some, the symptoms are mild and manageable, while for others, they can be debilitating, interfering with work, relationships, and overall quality of life. The intensity of symptoms can also vary from cycle to cycle, influenced by factors such as stress, diet, and overall health.

Premenstrual Dysphoric Disorder (PMDD)

While PMS affects a large number of individuals, a smaller subset experiences a more severe form of the condition known as premenstrual dysphoric disorder (PMDD). PMDD is a severe, sometimes disabling form of PMS that is recognized as a distinct clinical condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Symptoms of PMDD

The symptoms of PMDD are similar to those of PMS but are more severe and can be debilitating. The key difference lies in the intensity and the impact on daily life. The symptoms of PMDD include:

1. Severe Depression: Individuals with PMDD often experience intense feelings of sadness or despair, very rarely leading to suicidal thoughts or behaviors.

2. Extreme Irritability or Anger: The irritability experienced in PMDD can be extreme, leading to frequent or unexpected arguments, conflicts, or aggressive behavior.

3. Severe Anxiety or Panic Attacks: PMDD is often associated with high levels of anxiety, which can manifest as full-blown panic attacks.

4. Marked Mood Swings: The mood swings in PMDD can be extreme, with individuals rapidly cycling between different emotional states.

5. Severe Fatigue: The fatigue in PMDD can be overwhelming, leading to a significant decrease in energy levels and a reduced ability to carry out daily activities.

6. Difficulty Concentrating: Cognitive symptoms are pronounced in PMDD, with individuals often experiencing severe “brain fog,” memory problems, and difficulty focusing on tasks.

7. Loss of Interest in Daily Activities: A marked decrease in interest in activities that were once enjoyable is common in PMDD. This can include social activities, hobbies, and even basic self-care.

8. Physical Symptoms: In addition to the emotional symptoms, individuals with PMDD may experience physical symptoms similar to those seen in PMS, such as bloating, breast tenderness, headaches, and joint or muscle pain.

Diagnosis of PMDD

Diagnosing PMDD requires a thorough evaluation by a healthcare provider, typically involving a detailed history of symptoms. A key criterion for diagnosis is that the symptoms of premenstrual syndrome must be severe enough to interfere significantly with daily life and must be present during the majority of menstrual cycles over the course of a year. Additionally, the symptoms must subside with the onset of menstruation and be absent during the follicular phase of the cycle.

To confirm a diagnosis of PMDD, healthcare providers often ask individuals to track their symptoms over several menstrual cycles. This helps to establish the cyclic nature of the symptoms and their correlation with the luteal phase.

Treatment of PMDD

Treatment for PMDD typically involves a combination of lifestyle changes, therapy, and medication. The goal is to manage the symptoms and improve the individual’s quality of life. Treatment options may include:

1. Lifestyle Modifications: Regular exercise, a healthy diet, and adequate sleep are crucial in managing PMDD symptoms. Reducing stress through relaxation techniques, such as yoga or meditation, can also be beneficial.

2. Cognitive Behavioral Therapy (CBT): CBT is an effective treatment to alleviate any exacerbated mental symptoms. It helps individuals identify and change negative thought patterns and behaviors that may contribute to their symptoms.

3. Medications: Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), are commonly prescribed for PMDD. These medications can help alleviate both emotional and physical symptoms. Hormonal treatments, such as birth control pills or GnRH agonists, may also be used to regulate or suppress the menstrual cycle, thereby reducing symptoms. Unfortunately these options are not without risks.

4. Nutritional Supplements: Some individuals find relief from PMDD symptoms through the use of nutritional supplements, such as calcium, magnesium, and vitamin B6, although the evidence for their effectiveness is mixed.

5. Alternative Therapies: Acupuncture, herbal remedies, and other alternative treatments are sometimes used, though their efficacy varies, and they should be approached with caution and under the guidance of a healthcare provider.

Differentiating PMS from PMDD

It is important to distinguish between PMS and PMDD, as the management strategies may differ significantly. While premenstrual syndrome symptoms can be managed with lifestyle changes, over-the-counter pain relief, and other self-care measures, PMDD often requires more intensive treatment, including the potential need for psychiatric intervention.

Downsides of Birth Control as a Treatment

Hormonal birth control methods, such as pills, patches, injections, and intrauterine devices (IUDs), are widely used for contraception and managing menstrual-related conditions. These methods work by altering the body’s natural hormonal balance, which can lead to both physical and mental side effects. Physically, up to 30% of users may experience nausea, 20% may report weight gain, and around 30% might deal with breast tenderness, headaches, or changes in menstrual bleeding patterns. More serious risks include an increased likelihood of blood clots, with the risk estimated to be around 4 times higher compared to non-users, this is even a higher risk for those who smoke or have cardiovascular disease. Mentally, about 10% of users report mood changes, including symptoms such as depression, anxiety, or mood swings.

Moreover, recent studies have suggested that hormonal birth control may influence partner choice. The hormones in birth control can subtly alter a person’s natural attraction to certain traits, potentially leading them to choose partners who are less genetically compatible or different from those they might select without hormonal influence. This effect has raised concerns about the potential for choosing the “wrong” partner while on hormonal birth control, with implications for long-term relationship satisfaction. While the research is still evolving, it highlights the complex ways in which hormonal birth control can affect not only physical and mental health but also aspects of romantic relationships. The effects of hormonal birth control vary widely, and it’s essential for individuals to work closely with their healthcare providers to monitor any adverse effects and weigh the risks and benefits based on their personal health profiles.