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PMS demystified

Anxiety, depression, irritability and loss of confidence – collectively known as PMS, these are symptoms that women often suffer from just before their monthly cycle. AW explores.

Premenstrual syndrome (PMS) is a combination of premenstrual symptoms that range from being mildly annoying to severely debilitating. Five per cent of women experience the symptoms mentioned above.

Most women also experience some degree of physical symptoms such as bloating and mastalgia (breast pain) or breast tenderness. These symptoms appear in the latter half of the menstrual cycle and disappear or significantly regress after menstruation begins.

Premenstrual syndrome can be classified according to three degrees of severity: mild, moderate and severe. According to Dr. Ibrahim Abd Elrahman, Specialist Obstetrician and Gynaecologist at the City Hospital, Dubai, mild to moderate PMS does not interfere with a woman's social or professional life much. Severe PMS, however, makes women withdraw from social, personal and sometimes, even professional interaction. It affects about 3-10 per cent of women all over the world.

According to the American College of Obstetricians and Gynaecologists, at least 85 per cent of menstruating women have at least one PMS symptom as part of their monthly cycle. And most of these women have symptoms that are fairly mild and do not need treatment. Dr. Elrahman further explains that women who experience PMS are usually between their late 20s to early 40s, have only one child, a family history of depression, a medical history of postpartum depression or mood disorder, or are overweight. Women who are undergoing hormonal contraception experience less PMS.

The precise cause of PMS is still uncertain, but studies suggest that two neurotransmitters in the brain might be involved. The condition, as mentioned before, involved both physical and emotional symptoms. However, the following symptoms may also show: acne; fatigue; having trouble sleeping; upset stomach, constipation, diarrhea, headache or backache, appetite changes or food cravings, joint or muscle pain, trouble concentrating or remembering, tension, irritability, mood swings, or crying spells, and anxiety or depression.

If you think you have PMS, Dr. Elrahman suggests keeping a daily diary to record your problems. In this journal, you will note the date and rate of the symptoms you feel for over two menstrual cycles. Through this record, doctors can identify if you have PMS as well as its severity. This also weans those who suffer from real PMS to those who don't. After careful evaluation, doctors find that 40 per cent of women seeking treatment for severe PMS do not have the condition.

The treatment for PMS involves advice regarding diet and exercise. If there are underlying psychological issues, then a psychiatric review may be appropriate. Ideally, the management is carried out involving doctors, dieticians and possibly psychologists, and should involve traditional and complementary treatments such as supplementary Calcium Magnesium or complementary alternative medicine such as Reflexology and Cognitive Behavioural Therapy (CBT).

“PMS can also be addressed with medical treatments such as cycle modifying hormonal agents, which involves the use of newer oral contraceptive pills,” Dr. Abd Elrahman explains. The frequency of periods, and, as an effect of PMS, can be reduced by taking three pill packets back to back without a week's break in between.

Oestrogen patches have also helped women, but in this situation, forms of contraception other than the contraceptive pill should be used. Next, the doctor shares, is Antidepressants such as Selective Serotonin and Noradrenalin reuptake inhibitors (SSRI's and SNRI's). These two improve both the physical and psychological symptoms and need to be used only in the second half of the menstrual cycle to be beneficial. PMS can also be treated with Gonadotrophin Releasing Hormone (GnRH) analogues or hormones that switch off the ovaries, giving a temporary menopause-like state. They should only be used in those with the most severe symptoms.

“If the treatment is not effective then the diagnosis has to be reconsidered,” Dr. Elrahman emphasises. The treatments, he adds, should not be used continuously for more than six months because of the risk of bone thinning. If used with ‘add-back' hormonal therapy, then a yearly bone scan should be carried out. Surgical treatment is also an alternative for PMS. However, the only effective surgical treatment for PMS is removal of the ovaries. It is a drastic measure, and should only be considered as a very last resort. If PMS seems to be affecting your life significantly, then you should consult your specialist for advice and treatment.

For more information about PMS contact The City Hospital, Dubai at+971 4 4359999 or email

Health Issues for Women(Previous Features)

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