Premenstrual syndrome (PMS)

Diagnosis

Diagnosing Premenstrual Syndrome (PMS) involves differentiating it from similar conditions and establishing a consistent pattern of symptoms. Since there are no unique physical signs or definitive lab tests for PMS, diagnosis is often based on symptom patterns recorded over time.

Steps to diagnose PMS:

• Symptom Tracking:
  • Record symptoms in a diary or calendar for at least two menstrual cycles.
  • Note when PMS symptoms begin and end, and the dates of your menstrual period.
• Medical Assessment:
  • Discuss with your healthcare provider the symptoms you experience, their timing, and their impact on your life.
  • Your provider will confirm a PMS diagnosis if you have at least one symptom associated with PMS that starts within five days before your period and resolves within four days after it ends, recurring over at least three cycles.
• Exclusion of other conditions:
  • Certain conditions can mimic PMS symptoms, such as chronic fatigue syndrome, thyroid disorders, and mood disorders (e.g., depression and anxiety).
  • Your provider may perform tests like thyroid function tests or mood screenings to rule out other diagnoses.
• Questions your provider may ask:
  • Frequency and duration of your menstrual cycles and bleeding.
  • The severity of menstrual bleeding (light, medium, heavy).
  • Details about the onset, duration, and intensity of symptoms.
  • How predictable your symptoms are and how they affect your daily life.
• Review of medical and family history:
  • Information about your current medications and medical history.
  • Family medical history, especially if mood disorders are prevalent, as they can influence symptoms.
• Ruling out other potential causes:
  • Conditions like anxiety, depression, perimenopause, chronic fatigue syndrome, and thyroid disorders will be considered.

By carefully tracking symptoms and undergoing a thorough medical evaluation, healthcare providers can more accurately diagnose PMS and differentiate it from other conditions with similar symptoms.

Treatment

While lifestyle modifications can be beneficial for alleviating PMS symptoms in many women, the severity of these symptoms may influence the recommendation of medication by healthcare providers. Responses to medication vary among individuals in terms of symptom relief. Commonly prescribed medications for premenstrual syndrome include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal anti-inflammatory medicines (NSAIDs), such ibuprofen or naproxen sodium, when taken before or at the start of your period, can help reduce breast discomfort and cramping.

They are available over-the-counter, or if your symptoms are severe, your healthcare provider may prescribe a higher dosage.

• Hormonal contraceptives: Pain and other uncomfortable physical sensations, such as soreness, can be relieved with ovulatory blockers. To find the birth control that works best for you, you may need to explore a little at first. The patch, the ring, and birth control tablets are available options.
• Diuretics: Taking diuretics might help your body eliminate extra fluid through your kidneys when exercise and cutting back on salt aren’t enough to lessen the weight gain, swelling, and bloating associated with PMS. One diuretic that may assist with some PMS symptoms is spirolactone, also known as aldactone.
• Antidepressants: The signs and symptoms of depression have been successfully reduced by selective serotonin reuptake inhibitors (SSRIs), which include sertraline, paroxetine, and fluoxetine.

Premenstrual dysphoric disorder (PMDD) and severe PMS are treated with selective serotonin reuptake inhibitors (SSRIs) as the first line of treatment. Most people take these medications once a day. However, antidepressant use may be restricted to the two weeks before to the onset of menstruation in certain women with PMS.

• Lifestyle modification:
  • Regular exercise: You can reduce stress and improve your mood by engaging in 30 minutes of moderate aerobic exercise each day, such as jogging, brisk walking, cycling, or swimming. The advantages persist after thirty minutes.
  • Healthy diet: You can reduce PMS symptoms by eating less of some foods and more of others. Two weeks prior to your period, reduce the amount of salty, fatty, and sugary meals you eat and the amount of coffee and alcohol you drink. Eat six little meals a day rather than three large ones when you’re on your period. Alternately, consume three tiny meals and three tiny snacks. Eating well benefits both your stomach and your emotions. Meal spacing helps avoid digestive issues like diarrhea.
  • Adequate sleep: Sleeping for at least eight hours a night can help you feel less irritable. The additional benefit of synchronizing your internal clock to reduce mood swings during the day comes from going to bed and waking up at the same times every day.
  • Relaxation exercises: Breathing techniques, yoga, and meditation reduce stress and fight the anger and depression that PMS frequently brings on.