Premenstrual Syndrome – An Overview

 

N. Sakthi Bharathi¹, E. Kayalvizhi², Juliet Sylvia³

¹Assistant Professor, Sacred Heart Nursing College, Madurai.

²Associate Professor, MAHER, Kanchipuram.

³Principal, Alagappa Nursing College, Karaikudi.

 

 

ABSTRACT:

Premenstrual syndrome is an unpleasant physical, psychological and behavioral changes and which may lead to negative impact on social relationships, work productivity and other social activities. The severe form of Premenstrual syndrome may lead to Premenstrual Dysphoric disorder (PMDD).Premenstrual symptoms affected an estimated 90% of women of reproductive age, according to research. PMS prevalence rates in India have been observed to range from 14.3 percent to 74.4 percent. In India, the reported prevalence of PMDD has ranged from 3.7 percent to 65.7 percent.

 

 

INTRODUCTION:

Adolescents are the young and aged from 10 to 19 years, where a transformation from puberty to legal adulthood takes place. Worldwide, about 1.2 billion are adolescents who showed approximately one in every six person is an adolescent. In India about 243 million were adolescents that is about 21%.¹WHO classifies 'Adolescents' as individuals from 10 to 19 years and 'Youth' between 15 and 24 years, while 'Young People' from the age range of 10-24 years². According to Population Bureau in 1996, 30% of the total population was that of adolescents (284.02 million).³

According to Population Bureau in 1996, 30% of the total population was that of adolescents (284.02 million).

 

Menstruation is a landmark in every woman's life. It is a major physical event that transmits the female from girlhood to womanhood.

 

 

Menstrual cycles are not always regular or stable; they may be disturbed by many disorders which commonly occur at the extremes of reproductive age⁴.

 

PMS or Premenstrual syndrome is a widespread menstrual condition among adolescent and middle-aged women. It is defined as the recurring occurrence of a group of unpleasant physical, psychological and behavioral changes of such intensity to cause interpersonal relationships to deteriorate and/or interfere with regular activities, which resolve upon onset or shortly after menstruation⁵.

 

PMS is recurrent variable cluster of troublesome physical and emotional symptoms that develops 7-14 days before the onset of menstruation and subsides when menstruation occurs⁶.

 

PMS is a chronic illness that negatively affects relationships, work productivity, and social activities. In a population-based study, 91% of individuals reported at least one symptom, 10.3% had PMS, and 3.1 percent met the premenstrual dysphoric disorder criteria (PMDD). PMS and PMDD were revealed to be significantly associated to poor physical and mental health⁷.

Premenstrual symptoms affected an estimated 90% of women of reproductive age, according to research. Approximately 20 to 40 percent of the participants suffer from PMS, whereas 2 to 8 percent of them experience from PMDD. Similarly, it appears that PMDD prevalence varies by culture and ethnic group. PMDD prevalence is 2.4 percent in a statewide sample of Korean women, 3.3 percent in a Bulgarian population, 7.7 percent among female university students in Jordan, and even 17.6 percent among young adult women in southern Brazil⁵.PMS prevalence rates in India have been observed to range from 14.3 percent to 74.4 percent. In India, the reported prevalence of PMDD has ranged from 3.7 percent to 65.7 percent⁸.

 

Premenstrual syndrome is a psychoneuroendocrine disorder with an unknown cause that manifests itself soon before menstruation. During the last 7-10 days of the menstrual cycle, a big number of symptoms occur cyclically⁹.

 

Etiology and Risk factors:

The etiology of premenstrual syndrome is unknown.

·       Hormonal changes during the menstrual cycle, as well as hormonal imbalances such as oestrogen excess and progesterone deficiency, have been suggested. Serotonin has also been linked to symptoms as a significant etiological component.

·       According to molecular biology studies, low oestrogen causes the hypothalamus to emit nor-epinephrine, which causes a drop in acetylcholine, dopamine, and serotonin, resulting in sleeplessness, lethargy, and depression, all of which are classic PMDD and PMS symptoms.

·       Excessive consumption of sweets. Other factors, such as junk food and coffee use, were also found to be connected with PMS.

·       There is a link between PMS and PMDD and lifestyle factors.

·       Dietary factors like fast food, sugary drinks, and deep-fried foods, as well as lifestyle factors such as less habitual exercise and poor sleep quality are significantly associated with PMS¹⁰.

·       PMS is more likely in the late 20s to mid-40s and more severe in 40s

·       Older teens tend to have more severe PMS than younger teens.

·       Women who've had at least one pregnancy are more prone to PMS.

·       Women with a history of depression or other mood disorder may have more PMS symptoms¹¹.

 

Pathophysiology:

 

Signs and Symptoms:

Emotional and behavioral signs and symptoms:

·       Tension or anxiety

·       Depressed mood

·       Crying spells

·       Mood swings and irritability or anger

·       Appetite changes and food cravings

·       Trouble falling asleep (insomnia)

·       Social withdrawal

·       Poor concentration

·       Change in libido

 

Physical signs and symptoms:

·       Joint or muscle pain

·       Headache

·       Fatigue

·       Weight gain related to fluid retention

·       Abdominal bloating

·       Breast tenderness

·       Acne flare-ups

·       Constipation or diarrhea

·       Alcohol intolerance¹²(ACOG)

 

Impact of PMS:

Around half of women who need PMS medication also have another health concern that get worse in the weeks leading up to their menstruation.

 

Many women experience various premenstrual physical, emotional, or behavioral changes, which at times reach such levels of severity that they may have substantial social impact upon the woman herself, her associates, and her work¹³.

 

Depression and anxiety disorders:

Depression and anxiety disorders are two health issues that share many symptoms with PMS. These are the most prevalent overlapping conditions with PMS. PMS-like symptoms of depression and anxiety can worsen before or during menstruation.

 

Myalgic encephalomyelitis/chronic fatigue syndrome

Some women with Myalgic encephalomyelitis/chronic fatigue syndrome, experience that their symptoms worsen just before their menstruation. According to studies, women with these issues are more likely to have severe monthly flow and enter menopause early or prematurely.

 

Irritable bowel syndrome (IBS):

Cramps, bloating, and gas are all symptoms of IBS. Irritable Bowel Syndrome might become more severe just before menstruation.

·       Bladder pain syndrome:

Women with bladder pain syndrome are more likely to have painful cramps during PMS.

 

·       Other health problems:

PMS may also worsen some health problems, such as asthma, allergies, and migraines¹⁴.

 

Preventive Measures:

Lifestyle and dietary changes:

PMS can be treated depending on how severe the symptoms are. Dietary changes such as eating smaller amounts of meals more frequently, eating meals high in carbohydrate and low in salt or refined sugar, limiting caffeine and alcohol use, and stopping smoking are among the current therapy recommendations.

 

Endorphins are released as a result of exercise and physical activity, which improves overall health, nervous tension, and anxiety. Endorphins are chemicals that lead to euphoric experiences and have an impact on pleasure, pain perception, memory, and learning.

 

Stress Reduction Activities:

Emotional support from family and friends, counseling and education, individual and couples therapy, stress/ behaviour management tactics, anger management, self-help support group, and cognitive-behavioural therapy are all options for stress reduction and relaxation.

 

Management:

Nutritional Supplements:

Primary Nutrients:

·       EQUI-FEM : 2 tablets, 3 times daily with meals

·       BIO – C PLUS 1000: 1 tablet, 3 times daily after meals

·       M S M powder

·       OSTEO – B plus: 3 tablets, once daily after meals

·       BIOMEGA – 3: 4-5 capsules, twice daily after meals for one month, then 4-5 capsules once daily

      Specific Nutrients:

·       E- MULSION 200: 1 capsule, 3 times daily with meals

·       GAMMANOL FOERTE with FRAC: 2 tablets, 3 times daily with meals

·       MG – ZYME: 1 tablet, 3 times daily with meals

·       B6 PHOSPHATE – 1 tablet, 3 times daily

·       ZN – ZYME FORTE : 1 tablet, 3 times daily with meals

·       B12 / FOLATE PLUS: 2 capsules, 3 times daily with meals¹⁵.

 

Non Pharmacological Management:

In the research, some herbal and mineral supplements have been proven to help reduce the severity and duration of premenstrual symptoms. Daily calcium intake of 1000mg, magnesium intake of 200mg, 400 units of vitamin E, vitamin B6, chaste tree, consumption of St. John's Wort, intake of 3000-4000mg of evening primrose oil, Black Cohosh, and Dandelion are some of these herbs which are useful for PMS.

 

Non-hormonal medications:

Pyridoxine:

Pyridoxine 100mg twice daily helps in restoring tryptophan metabolism, which is particularly important after 'pill' depression.

 

Diuretics:

Fluid retention is reduced by taking furosemide 20mg everyday for 5 days in a row in the second half of the cycle.

 

SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective noradrenaline reuptake inhibitors):

This class of drugs has been demonstrated to significantly reduce PMS symptoms by having mood stabilising and antidepressant effects. They work by raising brain chemicals like serotonin and noradrenaline, which both appear to decrease in women with PMS during the premenstrual phase¹⁶.

 

Hormones:

Oral Contraceptive pills:

Oral contraceptives serve to inhibit ovulation and maintain a consistent hormonal environment. The medication will be continued for 3-6 weeks. Some newer oral contraceptive drugs contains the the progestin drospirenone. It contains anti-androgenic and anti-mineralocorticoid properties. Oral contraceptives that contain drospirenone have been reported to improve symptom control.

 

Progesterone:

It is not effective in treating premenstrual symptoms. Levonorgestrel intrauterine system had been used to suppress ovarian cycle.

 

Spironolactone:

It is a potassium sparing diuretic. It has antimineralocorticoid and antiandrogenic effects. It is given in the luteal phase (25mg-200mg/day). It improves the symptoms of premenstrual dysphoric disorder.

 

Bromocriptine:

Bromocriptine 2.5mg daily or twice daily may be helpful, at least to relieve the breast complaints.

 

Mirena IUD (Intra Uterine Device):

The Minera IUD releases a low-dose progesterone-like hormone that may assist some women suppress ovulation and lessen PMS symptoms.

Ovarian cycle suppression:

a.     Danazol: Danazol 200mg per day should be adjusted to cause amenorrhoea.

b.     GnRH: Administration of a GnRH agonist for six months suppresses gonadal steroids.

 

Oopherectomy:

Hysterectomy with bilateral oophorectomy is a last resort in established instances of primary Premenstrual syndrome with recurrence of symptoms and impending menopause¹⁷.

 

REFERENCE:

1.      Sivagurunathan, C. Adolescent Health: Present Status and Its Related Programmes in India. Are We in the Right Direction? Journal of Clinical and Diagnostic Research. 2015; https://doi.org/10.7860/jcdr/2015/11199.5649

2.      Adolescent health, WHO, 2018, https://www.who.int/health-topics/adolescent-health#

3.      Padmavathi.P., Sankar.R., Kokilavani.N. “A Study on the Prevalence of Premenstrual Syndrome among Adolescent Girls in a Selected School at Erode” Asian J. Nursing Edu. and Research 2012; 2(3): http://www.anvpublication.org/ajner.htm.

4.      Padmavathi.P., Sankar. R., Kokilavani.N., “Assess the Effectiveness of Self-Instructional Module on Knowledge of Premenstrual Syndrome among Adolescent Girls in Selected Area, Erode”. Asian J. Nursing Edu. and Research 2013; 3(3): http://www.anvpublication.org/ajner.htm.

5.      Bhowmick, M., Kharde, A. A longitudinal study on premenstrual disorders among female medical students of a tertiary-care hospital. International Journal of Medical Science and Public Health, 2014;3(12), 1531. https://doi.org/10.5455/ijmsph.2014.181020142

6.      Padmavathi.P., Sankar.R., Kokilavani.N., “A correlational study on Perceived stress and Premenstrual symptoms among adolescent girls at selected schools Pallakkapalayam, Namakkal (Dt).”, Asian J. Nursing Edu. and Research 2013; 3(1) http://www.anvpublication.org/ajner.htm.

7.      Zahid, (2016); https://www.nhp.gov.in/disease/gynaecology-and-obstetrics/premenstrual-syndrome

8.      Gao, M., Zhang, H., Gao, Z., Cheng, X., Sun, Y., Qiao, M., & Gao, D. Global and regional prevalence and burden for premenstrual syndrome and premenstrual dysphoric disorder. Medicine, 2022; 101(1), e28528. https://doi.org/10.1097/md.0000000000028528

9.      Dutta, A., and Sharma, A. Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in India: A systematic review and meta-analysis. Health Promotion Perspectives, 2021; 11(2), 161–170. https://doi.org/10.34172/hpp.2021.20

10.   Nivin Todd, M. D. A Visual Guide to Premenstrual Syndrome (PMS), 2020; https://www.webmd.com/women/pms/ss/slideshow-premenstrual-syndrome-pms

11.   https://www.webmd.com/women/pms/ss/slideshow-premenstrual-syndrome-pms

12.   ACOG, Premenstrual Syndrome: https://www.acog.org/womens-health/faqs/premenstrual-syndrome

13.   K. Pathak, Gururaj Udapi, “A Study to Assess the Knowledge Regarding Psychological Problems of Premenstrual Syndrome and its Management among Adolescent girls at Selected PU College of Belgaum City, with a View to Develop Informational Booklet, Asian Journal of Nursing Education and Research, 2017; 7(1):9. https://ajner.com/AbstractView.aspx?PID=2017-7-1-3

14.   Konar, H. DC Dutta’s Textbook of Gynecology (8th ed.).2022; Jaypee Brothers Medical Pub.

15.   https://www.dcnutrition.com/health-problems/pms-premenstrual-syndrome/

16.   https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome

17.    Johnson. T. C., PMS and the Pill, 2020; https://www.webmd.com/women/pms/pms-and-the-pill

 

 

Received on 18.05.2022           Modified on 08.06.2022

Accepted on 23.06.2022          © A&V Publications all right reserved