Premenstrual syndrome (PMS): What is it exactly?

What is premenstrual syndrome (PMS)?

Often, as their period approaches, women experience physical changes as well as changes in mood, which are sometimes reduced to old sexist clichés such as "Are you on your period or something?". Premenstrual syndrome does exist, however, and can be extremely incapacitating when it occurs.

Premenstrual syndrome, or PMS, is a recurrent disorder occurring during the luteal phase, the last phase of the menstrual cycle, which lasts 12 to 14 days between ovulation and the next period.

It affects about 20-50% of women of childbearing age. Of these, 5% have a severe form called premenstrual dysphoric disorder (PMDD).

The diagnosis of PMS is based on the patient's daily record of symptoms.

What are the different symptoms of premenstrual syndrome (PMS)?

The intensity of symptoms varies greatly from one woman to another. Some women will not experience any symptoms. For others, symptoms will be exacerbated and may even disrupt their daily lives. It also depends on the psychological, marital, family and socio-professional context in which she finds herself.

PMS varies according to both the menstrual cycle and the stage of life in which the woman finds herself; a teenager will not have the same symptoms as a post-menopausal woman. Also, premenstrual disorders are sometimes increased by sources of stress and conflict.

The most common symptoms are as follows:

Physical changes:

• Abdominal bloating and pain
• Water retention
• Digestive issues: constipation and/or diarrhea, nausea and/or vomiting
• Intense fatigue
• Low back pain, headaches, dysmenorrhea at the beginning of the period
• Acne
• Breast swelling and hypersensitivity
• Appetite changes and/or food cravings
• Weight gain

Mental/psychological changes:

• Mood swings, anger, irritability
• Anxiety, depression
• Insomnia
• Difficulty concentrating
  
  

Why do these symptoms occur and how long do they last?

The signs of PMS start in the luteal phase and end a few hours after the start of menstruation.

They are linked to hormonal changes in estrogen and progesterone levels, which are partly responsible for the physical and mental disruptions. The serotonin present in the brain could also contribute to the psychological symptoms. A potential genetic predisposition to PMS may also exist, as well as a connection to magnesium and calcium deficiencies.

There are risk factors such as smoking, a sedentary lifestyle, lack of sleep and obesity. As for diet, it can contribute to worsened PMS symptoms if it is too rich in caffeine, alcohol, red meat and sugar and low in calcium.

Premenstrual dysphoric disorder (PMDD)

PMDD is a severe form of PMS, causing symptoms severe enough to disrupt daily activities. It is seriously debilitating and can significantly affect mood, causing depression with a range of sudden and significant emotional symptoms. Suicidal ideation may also occur. Diagnosis is made through an assessment of daily symptoms experienced over a sustained period of time, around 12 months.

How to manage premenstrual syndrome (PMS)?

There is no one, proven treatment that works for all women.

Any treatment or medications will be prescribed based on the symptoms experienced, with advice and recommendations for lifestyle and diet changes to be implemented.

Here are a few general tips that can help during this period:

• Eliminate any stimulants (coffee, sugar, refined salts, alcohol, tobacco, etc.)
• Eat light, balanced meals at more frequent intervals
• Limit stress factors where possible
• Engage in regular physical activity
• Know when to take a break, get a good night's sleep
• Practice relaxation techniques (e.g., yoga, meditation, mindfulness, deep breathing).

If the pain is severe and has too great an impact on daily life, and if dietary and lifestyle changes are insufficient, the doctor may prescribe an anti-inflammatory treatment (NSAIDs) to relieve pain and/or a hormonal treatment (progesterone, oral contraceptives) to restore hormonal balance and regulate the menstrual cycles.

Certain dietary supplements can also be moderately effective: vitamin B6, magnesium, calcium, ginkgo, vitamin E, vitex (chasteberry), etc. The use of supplements shouldn't be use without prior advice from a doctor because of the potential risks associated with epilepsy or kidney failure, for example.

Patients who are reluctant to use hormonal treatments can try alternative medicines to relieve their symptoms (homeopathy, acupuncture, phytotherapy and mesotherapy).

Psychotherapy, such as talk therapy or counseling, can help a woman learn to cope better with the symptoms. Cognitive behavioral therapy (CBT) may be useful if mood problems are a major concern.

For severe symptoms, especially those related to premenstrual dysphoric disorder, antidepressants, anxiolytics and sometimes even a GnRH agonist (gonadotropin-releasing hormone agonist) to prevent ovarian hormone production will be prescribed. 

In the case of even more severe symptoms, bilateral oophorectomy (ovarian removal surgery) may relieve symptoms as it suppresses menstrual cycles. 

Apps to help you track your menstrual cycle and related symptoms

In order to improve women's health monitoring, technological advances have allowed many menstrual cycle monitoring apps to emerge. The objective of these applications is to allow each woman to obtain personalized follow-up, so each user is invited to provide personal data related to her mood and her physical feelings throughout her menstrual cycle. 

These apps typically ask for: an estimation of the average length of your period and menstrual cycle, your PMS symptoms, the date of your last period, your height, weight, age, type of contraception used, your flow, etc.

Here are some examples of apps: Clue, Flo, Ovia, Eve by Glow, etc. 

These apps allow you to better understand your menstrual cycle, to record all the signs of PMS, to listen to your body and your mental health and thus to better control and relieve your symptoms. 

Not everyone who has a period has a bad experience, but PMS is a reality and should not be trivialized. It affects both physical and mental health.