Premenstrual Syndrome

(Premenstrual tension)

For 7-10 days before period and usually disappearing a few hours after onset of menses:

  • nervousness

  • irritability

  • emotional instability

  • anxiety

  • depression

  • possibly headaches

  • oedema

  • mastalgia

Aetiology

  • fluctuations in oestrogen and progesterone

    • ?leading to transitory fluid retention

  • difference in progesterone metabolism

    • less allopregnanolone (enhances GABA-A receptor function, anxiolytic)

      • affected by L-tryptophan challenge so related to serotonergic system

    • more pregnenolone (opposite)

  • changes in cerebral vascular blood flow

    • SPECT scanning reveals decreased blood flow in temporal lobes in PMS

    • Magnesium supplementation improves migraine and oestrogen alter Mg++ concentrations in cells

  • changes in cortisol timing

  • ? greater increase in leptins during luteal phase

  • sexual abuse (95% in one study)

Symptoms and signs

  • variable

  • few hours to 10 days

  • usually cease when menses begin but may persist through menses in perimenopausal women

  • some develop dysmenorrhoea when menses begin, commoner among teenagers and diminishes with age

  • Psychological

    • irritability

    • nervousness

    • lack of control

    • agitation

    • anger

    • insomnia

    • difficulty in concentrating

    • lethargy

    • depression

    • severe fatigue

  • Fluid retention

    • oedema

    • transient weight gain

    • oliguria

    • breast fullness and pain

  • Neurological / Vascular

    • headache

    • vertigo

    • syncope

    • paraesthesia of extremities

    • easy bruising

    • cardiac palpitation

    • aggravation of epilepsy

  • GI symptoms

    • constipation

    • nausea

    • vomiting

    • changes in appetite

  • Pelvic

    • pressure / heaviness

    • backache

  • Skin

    • acne

    • neurodermatitis

    • aggravation of other skin complaints

  • Respiratory conditions worsen

  • Eye complaints worsen

Treatment

Relief of symptoms