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By Dr J Kabyemela, MD

Nobody knows for sure how many women are affected by Premenstrual Syndrome (PMS). There is however a universal acknowledgement of its existence even if it is rather difficult to pin-down.

PMS ( also known as Premenstrual Tension or PMT) is a collection of symptoms which would differ from individual to individual but retaining the common thread which is the timing. Symptoms build up in a crescendo fashion in the lead up to the onset of the menstrual period and are typically recurrent following the menstrual calendar. The medical term for Pre-menstrual Syndrome is Premenstrual Dysphoric Disorder (PMDD)


PMS symptoms:

Women suffering from PMS will have some or all of these symptoms:

Fatigue

Emotional fragility

Mood swings

Bouts of crying with little or no reason

Feeling of uncontrollable anger or rage

Difficulty with interacting with other people

         including family and friends

Difficulties with sleep

Restlessness

Poor concentration

Feeling bloated

Breast fullness and/or tenderness

Headaches

Loss of interest in sex


It is clear from this list, which is by no means exhaustive, that many women do suffer some of these symptoms to some degree.  The physical symptoms such as bloatedness and breast tenderness are particularly common. Their presence, especially in isolation, does not make a diagnosis of PMS.


What Causes Pre-menstrual Syndrome (PMS)?

The exact cause of PMS remains unknown. There is some evidence of genetic pre-disposition. The theory of an unusual reaction of the body and brain to the hormones so far remains unsubstantiated. Certainly repeated studies based on checking hormone levels of affected women during this phase of the cycle have always returned normal results. The evidence is strong that there isn’t any sort of hormone imbalance despite all the temptation to blame this. However, PMS is real enough and it is a very debilitating recurrent problem that affects the individual and all those close to her.


What about serotonin and PMS?

Theories abound about the role of serotonin, a chemical produced in the brain which plays the role of a neuro-transmitter. Serotonin plays an important regulatory role in all sorts of emotions including general mood, anger, aggression and even sleep and appetite. It is hypothesized, with some evidence, that some people have a genetic predisposition to levels of production of serotonin being interfered with by ovarian hormones. It is a highly complex subject where a lot of scientific research has gone on for years.


Treatment options for PMS

Since there is no confirmed cause of this condition, there is no specific treatment either. Several remedies have been tried over the years with variable success. Some will work well for some and be disappointing for others.


It is essential for the individual sufferer to bear the above fact in mind when looking for an effective solution. It may take a few attempts at a number of options before a suitable one for her is found.


SSRIs: This stands for Selective Serotonin Re-uptake Inhibitors. Their effect is to maximize the presence of Serotonin in the brain. Their use is therefore based on the hypothesis described above about the role of this chemical (Serotonin). They don’t work for everybody but they are certainly worth a shot for any sufferer. SSRIs are more famous for their role as anti-depressant. Examples include Fluoxetine and Paroxetine. A study published in the April 2008 issue of The Journal of Clinical  Psychopharmacology reported that an SSRI Escitalopram also known by brand names Lexapro, Cipralex, Sipralexa and Seroplex  had been shown to be very effective in controlling many of the PMS symptoms including irritability, depressed mood, tension and mood swings. These were reduced by as much as 90% at adose of 20mg/day. The effect on symptoms like breast tenderness and lethargy was much more modest.


Combined Pill: The combined oral contraceptive pill has also been employed, to control symptoms of PMS. The logic behind is to abolish the cycle replacing it with the ‘artificial cycle’ created by the Pill. It works for some.


GnRH analogues: This is a group of drugs which work by temporarily shutting down the hormone production of the ovaries. The menstrual cycle is therefore abolished by mimicking menopause. Because of that mechanism of action, this treatment can only be short-term, normally not lasting more than 6 months at a time. Moreover, apart from absence of periods, these drugs also have significant other side-effects including hot-flushes and sweats. However additional medication can be taken alongside to ameliorate these unwanted side effects.


Pain-killers such as Aspirin and Ibuprofen (NSAIDs) can be useful in dealing with some of the symptoms


Diuretics: these could help relieve the bloated feeling caused by fluid retention


Lifestyle Intervention: A healthy diet and exercises have a proven record on having an effect in reducing symptoms and whenever possible, this is encouraged.


Dietary supplements: These have been advocated and used with variable results. Those used include Vitamin B6, Magnesium, Vitamin E, calcium supplements and the amino acid tryptophan (from which serotonin is produced)


Saffron: This is an exotic spice prepared from the Crocus sativus flower.  This is a wild flower found mSaffron flowerainly in Iran, the mediterranean and other parts of the Near East. A study published in the March  2008 issue of the British Journal of Obstetrics and Gynaecology (BJOG) showed that there was evidence that Saffron could help relieve PMS symptoms. Its mode of action is not clearly understood but Saffron contains over 150 different compounds. Further studies are sure to follow. Unfortunately, because of its exotic nature, saffron is a particularly expensive product.


What role Evening Primrose in PMS?

This is a popular product for a number of ailments. Evening Primrose contains γ-linoleic acid (Gamma-LA). Scientific evidence of Evening Primrose’s effectiveness in PMS is still lacking.




Last update: March 30, 2013





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