Premenstrual syndrome (PMS) is a relatively common hormone problem. It refers to the occurrence in the second half of the menstrual cycle of a group of physical, psychological and behavioral symptoms that interfere with life activity.

Diagnosis

There are three important components to the diagnosis of PMS:

• The symptoms are cyclical
• The symptoms occur in the second half of the menstrual cycle during or after ovulation
• Symptoms are severe enough to interfere with aspects of daily life

Common PMS symptoms

Emotional
Physical
Behavioural
Anxiety
Headaches
Food cravings
Irritability
Migraines
Increased alcohol
Unstable moods
Breast tenderness
intake
Depression
Swelling of the legs
Decreased motivation
Anger
Bloatedness
Decreased efficiency
Sadness
Fatigue
Avoidance of activities
Crying easily
Abdominal cramps
Staying at home
Nervous tension
Aches and pains
Sleep changes
Oversensitivity
Weight gain
Libido changes
Hot flashes
Social isolation
Poor concentration
Forgetfulness

Who suffer from PMS?

Any women of reproductive age (from puberty to menopause) may experience PMS. Women who have had a hysterectomy and retained their ovaries may also suffer from the condition.

Causes of PMS

We still don’t know what causes PMS. Many theories have been proposed to explain the condition but none has been proven beyond doubt. All that we know is that it is related to hormone fluctuation in the body, especially progesterone.

Treatment of PMS

1. Nutritional modifications:
This may help up to 30% of women. A well-balanced diet may be helpful. Caffeine and alcohol should generally be avoided. Vitamin B6 (pyridoxine) has been used with mixed results. Vitamin E has also been shown to benefit some PMS symptoms but the response is again unpredictable. In general, nutritional therapy does not result in a consistent improvement of the symptoms.

2. Suppression of ovulation:
This may be achieved with the use of the oral contraceptive pill. Alternative methods including Danazol and GnRH agonist. The latter hormone suppresses secretion of two hormones from the pituitary gland, follicle stimulating hormone (FSH) and luteinising hormone (LH) which in turn causes the ovaries to stop producing hormones.

3. Diuretics:
Diuretics may be used to reduce symptoms associated with water retention. The most effective way to use diuretics is to start one or two days before the expected onset of fluid retention symptoms and continue the therapy until menstruation starts.

4. Antidepressants:
Fluoxetine (Prozac) has been shown to help the emotional symptoms particular depression, and appetite cravings associated with PMS. It is however not effective in reducing physical symptoms. The usual dose is 20 mg daily. The common side effects of Fluoxetine are anxiety, nervousness and loss of interest in sex.

5. Other medications:
Progesterone or progestogen treatment was popular in the past but is rarely used nowadays because only few women obtain benefit from it. Evening primrose is also worth trying, but the response is again unpredictable.

6. Surgical treatment:
If non of the above medical treatments work, surgical treatment may be considered in women with intractable premenstrual symptoms. Surgical treatment involves the removal of both ovaries and uterus (hysterectomy) which would eliminate the hormone fluctuations. It is possible to administer hormone replacement therapy afterwards, consisting of only oestrogen. Surgical treatment should be considered as the last resort, in women who have finished their family.

Prof T C Li