Premenstrual syndrome (PMS) is a set of physical and psychological symptoms that start anywhere from a few days to two weeks before a woman gets her monthly period (menstruation). A woman’s menstrual cycle lasts an average of 28 days. Ovulation, the period when an egg is released from the ovaries, occurs on day 14 of the cycle. Menstruation, or bleeding, occurs on day 28 of the cycle. PMS symptoms can begin around day 14 and last until seven days after the start of menstruation.
Symptoms of PMS fall into two general categories:
While often used as an idiom of distress, PMS can be a debilitating condition affecting women’s daily function. According to a journal (called American Family Physician), the symptoms affect up to 85 percent of menstruating women. 20-33% of women report moderate to severe symptoms that affect some aspect of their life. In this study, 3-8% reported severe depression, irritability, and tension before menstruation, defined as Premenstrual Dysphoric Disorder (PMDD), a severe form of PMS with more psychological symptoms. Another study reported that women in their 30s are more likely to have PMS, for reasons as elusive as its cause.
What causes the menstrual symptoms.
What causes premenstrual syndrome is not completely clear as research has not supported a simple excess or deficit of a hormone as a reason behind these symptoms. It appears that a woman’s response to the collective hormonal changes affects the way the chemicals in their brain (or neurotransmitters) function, thereby leading to the characteristic psychological as well as physical PMS symptoms. PMS can also be hereditary and the symptoms can be passed on from mothers to their daughters. Our lifestyle may also play a significant role in PMS.
Symptoms of PMS
Tissues in our body are sensitive to the hormone levels that change throughout a woman’s menstrual cycle. Studies suggest that rising and falling levels of hormones – like estrogen and progesterone – may influence other hormones and neurotransmitters, as they all work in a concerted fashion.
What happens when oestrogen levels rise:
- Oestrogen levels increase after menstruation, beginning a new cycle, which makes the endometrium or the uterus lining thicken. Later in the cycle (right around the time of PMS) the cells in the endometrium start to produce large amounts of hormone-like compounds that we call prostaglandins. They trigger off contractions in the uterine muscles, causing abdominal pain. High levels of prostaglandins during PMS are also associated with breast pain and headaches.
On day 14th of our cycle, oestrogen levels drop and progesterone levels start to rise.
What happens when oestrogen levels drop:
- When oestrogen levels drop, a hormone called serotonin drops as well. Also called the happy hormone, serotonin normally makes us feel good and positively influences our mood. Low serotonin levels are thought to contribute to premenstrual depression, as well as fatigue, impulsive behaviour, irritability, crying spells and intense craving for food, especially carbohydrates.
- The function of a region of the brain called the hippocampus (which is involved in cognition and memory) is affected. The hippocampus responds to oestrogens, so its low levels may cause forgetfulness.
- Oestrogen withdrawal occurs which is thought to be the trigger for headaches that arise during PMS.
What happens when progesterone levels increase:
- Progesterone levels are high during PMS and when its broken down, the by-products become active in the brain and alter the function of the brain chemical called Gamma-Aminobutyric acid (GABA) which is associated with cognitive function. Altered GABA functioning may result in difficulty in concentration.
- Progesterone is the main hormone that causes water retention. It also activates the function of aldosterone which increases the size of the blood vessels facilitating the accumulation of water into the tissues. This is why physical symptoms like weight gain and swelling (abdomen, feet, and ankle), bloating, breast tenderness are most prevalent in PMS.
- Higher progesterone levels also increase the production of an oily substance (‘sebum’) from glands called sebaceous glands in our skin, as well as close the pores. This excess production of sebum along with closed pores causes the sebum to build up in the skin and get stuck beneath the skins surface resulting in acne.
- Progesterone and its breakdown products affect the quality of sleep sometimes. Furthermore, during PMS there is a decrease in the secretion of melatonin (the hormone that helps you fall asleep) which could explain the difficulty of falling asleep as well.
Other Lifestyle Causes
PMS symptoms appear to be most troubling in women who smoke, lead stressful lives, rarely exercise, sleep too little, have a diet high in Caffeine, Alcohol, Salt, Red meat and Sugary foods. However, it’s not clear whether these factors increase your risk of PMS or if PMS accounts for these differences in lifestyle. For example, it is more likely that PMS causes stress rather than that stress causes PMS.
Relieve your PMS symptoms with these evidence-based tips
- According to research, 30 min of daily aerobic exercise throughout the month can help with symptoms such as depression, difficulty concentrating, and fatigue. Including exercise in your routine can also help you sleep better and balance your hormones to a great extent.
Get enough sleep
- Lack of sleep is also linked to depression and anxiety and can make PMS symptoms such as moodiness worse, so sleeping enough daily helps. [link to sleep post]
Avoid caffeine, nicotine and alcohol
- Caffeine enhances PMS symptoms like irritability and jitteriness so cutting down on caffeine two weeks before your period may lessen many PMS symptoms.
- In one large study, women who smoked reported more PMS symptoms and worse PMS symptoms than women who did not smoke, so reduce smoking.
- Regular use of alcohol causes major disturbances in the metabolism of brain serotonin levels.
Practise stress-relieving techniques
- Cope with stress by talking to your friends or writing a journal. Some women also find yoga, massage, or meditation helpful.
Eat a healthy, balanced diet
- Tryptophan is an amino acid which is also a precursor of serotonin-the brain chemical which regulates our mood. Generally, foods high in protein, iron, riboflavin (vitamin B2), and vitamin B6 all tend to contain large amounts of tryptophan. Eating tryptophan rich foods like eggs, dairy, nuts, seeds, soy products and fish with healthy carbohydrates, like rice, oatmeal, or whole-grain bread helps to boost serotonin.
- Vitamins and minerals like vitamin D, magnesium, vitamin E and vitamin B6 have all been reported to soothe symptoms. Calcium also influences the functioning of brain chemicals and has thus become a therapeutic target for PMS. Trials with supplemental calcium in dosages as low as 500 mg daily in women who experience moderate-severe PMS have shown significant decrease in symptoms.
- Omega 3 fatty acids (from fish, avocadoes, and flax seeds) suppress the production of prostaglandins and help manage pain.
- Gamma-linoleic acid found in evening primrose oil, has a long history of being used for PMS. It has even been shown to help reduce inflammation and the symptoms of premenstrual syndrome.
- Reduce the consumption of fast food and packaged foods. They tend to be very highn in salt. Eating less salt is particularly recommended for patients with bloating, breast tenderness or swollen hands
PMS symptoms can recur, but they typically go away after the start of menstruation. A healthy lifestyle and a balanced diet can reduce the symptoms for most women.
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