DISODERS RELATED TO THE MENSTRUAL CYCLE

By PAUL
PREMENSTRUAL SYNDROME
The premenstrual syndrome (PMS) is characterized by
the presence of both physical and behavioral
symptoms that occur repetitively in the second half of
the menstrual cycle and interfere with some aspects of
the woman's life.
Essentials of Diagnosis

Symptoms include oedema,weight

gain,restlessness,irritability and increased tension
Symptoms must occur in the 2nd half of the menstrual
cycle
Symptoms must occur in each of 3 consecutive cycles
Symptoms must be severe enough to require medical
Incidence of PMS
Is a pyschoneuroendocrine disorder with
biologic,pyschologic and social parameters
Upto 90% of women suffer recurrent PMS symptoms
Greater than 50% of women in the workplace have this
syndrome .
This leads in loss of time in work and efficiency loss
resulting
20-40% are mentally or physically incapacitated in
some degree and 5% experience severe distress
Highest incidence is in women in their late 20’s and
early 30’s
 PMS is rarely encountered in adolescence
NB There has been legal implications in regard to
the personal accountability of women who have PMS
and who commit criminal acts during the
periodvoftime just prior to onset of menses
Clinical features

Behaviour symptoms
Nervousness
 irritability
agitation
 unreasonable temper
Sleep disturbances
Fatigue
Lethargy
Depression
Acts of violence suicide
Neurological symptoms
Headache (most common)
Vertigo
syncope
paraestesia of hands and feet
aggravation of epilepsy
Respiratory symptoms
Hoarseness of voice
Allergic rhinitis
asthma
Gastro-intestinal symptoms
Abdominal bloating
 nausea and vomiting
 constipation
 colicky pains
increased or reduced appetite
Other symptoms
Oedema
Temporary weight gain
Palpitations
Sense of pelvic weight
Backache
oliguria
enuresis
capillary fragility
skin problems – acne, flaring up of existing
dermatological diseases
Breast changes – pain,tenderness,heaviness
Poor judgement
Poor concentration
Crying spells
Food cravings
Social withdrawal
TREATMENT

Psychotherapy
Diuretics –hydrochlorothiazide 500mg tds in the
premenstrual wk (21-28 days)
Oral progesterone – norethestrone 500mg bd in the
latter part of the cycle
Mild transquillizers –diazepam 2.5mg BD
In severe cases elimination of the cyclic ovulatory
hormonal changes can yield total relieve – depo
provera 150mg every 3 months or combined oral
contraceptives
Exact cause is unknown but various factors may
contribute
Cyclic changes in hormones
Sign and symptoms change with hormonal
flactuations and disappear with pregnancy and
menopause
Chemical changes in the brain
Fluctuations of serotonin plays a crucial role in mood
states, triggers PMS symptoms
Insufficiency may contribute to premenstrual
depression,fatigue, food cravings and sleep disorders
Depression

Some women with severe PMS have undiagnosed

depression though depression alone does not cause all
the symptoms.