• Users Online: 1356
  • Print this page
  • Email this page

Table of Contents
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 1-4

Those few horrible days: Premenstrual syndrome

Department of General Surgery, Military Hospital Devlali, Nasik, Maharashtra, India

Date of Submission22-Aug-2019
Date of Decision01-Sep-2019
Date of Acceptance23-Jan-2020
Date of Web Publication12-Jun-2020

Correspondence Address:
Dr. Gurmeet Singh Sarla
Department of General Surgery, Military Hospital, Devlali, Nasik - 422 401, Maharashtra
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/BMRJ.BMRJ_21_19

Rights and Permissions

Premenstrual syndrome (PMS) is a distinct clinical syndrome during the recurrent luteal phase of menstrual cycle wherein there is a significant deterioration in the quality of life due to disruptive physical and psychiatric symptoms caused by an abnormal central nervous system response to the hormonal changes of the female reproductive cycle. It happens in the postovulation phase because estrogen and progesterone levels fall dramatically if there is no pregnancy. Physical symptoms include breast tenderness and bloating sensation, and emotional symptoms may manifest as mood swings, depression or feeling of hopelessness, intense anger and conflict with others, tension, anxiety, irritability, decreased interest in usual activities, difficulty in concentrating, fatigue, and changes in appetite. Symptoms emerge 1–2 weeks before menses and resolve completely with the onset of menses. This review article outlines the pathophysiology, presentation, severity and timing of symptoms, diagnosis and treatment of PMS and reiterates that it is a transient and physiological phase during the menstrual cycle and not a pathological entity.

Keywords: Mastalgia, premenstrual syndrome, premenstrual dysphoric disorder, premenstrual molimina

How to cite this article:
Sarla GS. Those few horrible days: Premenstrual syndrome. Biomed Res J 2020;7:1-4

How to cite this URL:
Sarla GS. Those few horrible days: Premenstrual syndrome. Biomed Res J [serial online] 2020 [cited 2024 Feb 26];7:1-4. Available from: https://www.brjnmims.org/text.asp?2020/7/1/1/286559

  Introduction Top

Premenstrual syndrome (PMS) is the boogeyman of the menstruation cycle and is a blend of physical and emotional manifestations, which numerous ladies get in the postovulation period and just before the beginning of their menstrual period. It occurs after ovulation since estrogen and progesterone levels start falling significantly if there is no pregnancy. Physical symptoms incorporate breast tenderness and bloating sensation. Emotional symptoms of PMS may show as emotional episodes, sadness or feeling of misery, serious resentment and strife with others, strain, tension, crabbiness, diminished enthusiasm for common exercises, trouble in concentrating, fatigue, and changes in appetite. Mood symptoms are only present for a specific period, during the luteal phase of the menstrual cycle, and develop about 2 weeks before menses and resolve totally with the beginning of menses.

  Definition Top

During the years of conception, about 80%–90% of menstruating ladies experience symptoms in the form of breast pain, bloating, acne, and constipation that caution them of impending menstruation or premenstrual molimina. PMS is the recurrent luteal phase deterioration in the quality of life due to disruptive physical and psychiatric symptoms. It is a distinct clinical condition caused by an abnormal central nervous system response to the hormonal changes of the female reproductive cycle.

PMS is the standard premenstrual experience of ovulatory ladies causing irritation. This ought to be recognized from premenstrual dysphoric disorder (PMDD) wherein side effects, especially mental, lead to real trouble that is adequate to meddle with everyday exercises and disturb relational connections. The test to the restorative calling is to separate between these conditions and to offer fitting and auspicious intercessions.

  Prevalence Top

Discoveries of imminent and review studies propose that 5%–8% of women with hormonal cycles have moderate-to-severe symptoms. Nonetheless, a few examinations recommend that up to 20% of all ladies in the fertile age group have premenstrual grumblings that could be viewed as clinically relevant.[1]

  Presentation Top

The term of indications may last from 5 to 14 days and may frequently intensify altogether 7 days prior and top at around 2 days before the following menstrual cycle.[2] Anger and irritability are the most extreme protests and begin somewhat sooner than other symptoms.[2]

  Pathophysiology Top

Since most ladies of conceptive age report in any event gentle premenstrual indications, a specific level of uneasiness during the luteal stage ought to be viewed as physiological instead of pathological. Luteal state of mind changes could be leftovers of the oestrous cycle-related variances in conduct appeared by lower species with the first motivation behind advancing multiplication: sexual receptivity being expanded and hostility diminished when estrogen is high before ovulation.[3] In general, rehashed pregnancies, lactation, or malnourishment prompted expanded times of amenorrhea, a circumstance that has changed by advances in sustenance and with our ability to control reproduction.[4] The outcome is that women today have longer times of cyclic vacillations of estrogen and progesterone with related premenstrual symptoms.[4] All things considered, PMS has developed as a 20th-century marvel to some degree because of the way that ladies' expanding command over reproduction has disposed of the cycle of rehashed pregnancy and lactation that once in the past described the lives of ladies from adolescence to menopause.[5]

  Diagnosis Top

History is pathognomonic, and it is consistently a clinical analysis. PMDD is analyzed when in any event five of the accompanying symptoms occur a week to 10 days before menstruation and go away within a few days of the start of the menstrual period [Table 1].
Table 1: Diagnosis of premenstrual dysphoric disorder

Click here to view

  Typical History Top

A typical lady with PMDD may relate that she is a beneficial worker and great mother for the greater part of the month. Nevertheless, beginning at some point after ovulation might be 7 days before her periods, she stirs in the first part of the day with sentiments of peevishness, outrage, tension, or misery. At work, she may encounter sentiments of distrustfulness and wonder if colleagues are singling out her. Frequently, she will report that she experiences issues focusing on the job that needs to be done. She may encounter menopausal-like hot flashes and night sweats and regularly reports sleep interruptions with distinctive dreams. She expresses that premenstrually she goes overboard to things that her kids ordinarily do around the house, and this makes her feel like a terrible mother. She may feel down, however, not able to comprehend why since she realizes she has a decent mate, a great job, and healthy kids. Minor things that her life partner says might be sufficient to trigger a contention, and nothing the mate says can mollify her. Despite the fact that she might want to be held and ameliorated on such occasions, she reports that she cannot remain to be touched. In extreme cases, she may attempt to separate herself by locking the entryway to her room or unplugging her phone. Often gloom, outrage and animosity or uneasiness might be extraordinary, bringing about worries for the welfare of the affected lady or her relatives.[6]

  Management Top

Eat enough proteins and stay away from junk food and engage in customary exercise. Avoid sugar and refined carbohydrates and reduce caffeine and liquor admission. Consume green tea and the inclusion of fish in the diet is recommended. Consume healthy fats and avoid gorging and fasting. Not getting enough rest can execute your state of mind in case you are weeks from your period, and getting adequate sleep is important. Learn to manage stress. The trigger usually are little things which annoy you or make you sad. The best way to reduce irritability is to figure out what is making you irritable and then either address it or ignore it. Get quiet or alone and have your own space and time.

Brain fog

It is a mix of feeling of sluggishness and absent-mindedness and is a typical manifestation of PMS. In a run of the mill cycle, progesterone levels ascend in the 2 weeks paving the way to menstruation that has been connected to a drop in serotonin, a neurotransmitter that lifts state of mind and helps keep you sharp.

Happiness hormones

Biochemical processes are responsible for the release of so-called happiness hormones, and the most prevalent ones are endorphins, dopamine, and serotonin.

Weight gain in women

Women are bound to increase belly fat, especially deep inside the belly, as they go through perimenopause to menopause. This is because as estrogen levels reduce, body fat is redistributed from the hips, thighs, and buttocks to the abdomen.

Cyclical mastalgia

The breasts develop due to an increase in estrogen during puberty. During the menstrual cycle, at the time of ovulation, there is a rise of estrogen levels causing changes in breast tissue in the form of tightness, lumpiness, and pain in the breasts, which is cyclical in nature and subsides after menstruation.

  Epidemiology Top

Surveys have found that as many as 70% of daughters of affected mothers were themselves PMS sufferers, whereas 63% of daughters of unaffected mothers were symptom free.[7]

PMS vanishes during the suppression of the ovarian cycle during hypothalamic amenorrhea due to excessive physical or nutritional stress, during lactational amenorrhea, pregnancy, and after menopause either natural or induced.[8]

PMS vanishes after natural, medically or surgically induced menopause although the reintroduction of exogenous hormone replacement therapy may be associated with the reappearance of symptoms.[9]

PMS symptoms are likely to get worse when women reach perimenopause.

  Drugs Top

Mefenamic acid (500 mg thrice daily) in the premenstrual and menstrual weeks has outperformed placebo for the treatment of PMS in some, but not all clinical trials.[10]

Extended cycle combined hormonal contraceptives,[11] and oral contraceptives containing the progestin drospirenone[12] have proven superior to placebo in randomized clinical trials.

Pyridoxine (Vitamin B6) (100 mg OD) has been used with varied results in women with distressing molimina.[13]

Alprazolam (0.25 mg twice daily) or triazolam (0.25 mg) may be prescribed sparingly for some women who report overriding symptoms of anxiety and tension or insomnia.[14]

Estrogen withdrawal has been implicated in menstrual-related migraines and short-term estrogen supplementation,[15] oral sumatriptan therapy[16] or medical ovarian suppression with GnRH agonists,[17] and continuous combined hormone replacement therapy has been found to be of use.

A range of newer antidepressant medications that augment central serotonin activity has been shown to alleviate severe PMS.[18] Selective serotonin reuptake inhibitors, such as fluoxetine, sertraline, paroxetine, fluvoxamine, and venlafaxine (a serotonin and norepinephrine reuptake inhibitor), have all been successfully employed.

  Conclusion Top

PMS is a transient stage which a lady experiences after ovulation and before the beginning of her menstrual period and is completely physiological and not neurotic. During this period of the menstrual cycle, the lady feels bloated and has mastalgia notwithstanding feeling bothered, irate, miserable, desolate, and awful. The symptoms are often so serious that they meddle with everyday activities and even disturb relational connections. Outrage and fractiousness are the most serious complaints and begin soonest. It is because of the cyclic changes of estrogen and progesterone during the luteal period of the menstrual cycle. History is pathognomonic, and it is consistently a clinical analysis. Management involves eating and resting soundly, maintaining a strategic distance from caffeine and liquor, exercise and pursuing a hobby, and giving time and space to self. Numerous medications have been utilized with constrained achievement and are pharmaceutical industry driven. Compassion and empathy from spouse and children is expected, and patient ears who are receptive to the, may be-unreasonable small, little needs and demands of the woman during this difficult phase of menstrual cycle goes a long way in helping her tide “those few horrible days.”

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Borenstein JE, Dean BB, Endicott J, Wong J, Brown C, Dickerson V, et al. Health and economic impact of the premenstrual syndrome. J Reprod Med 2003;48:515-24.  Back to cited text no. 1
Pearlstein T, Yonkers KA, Fayyad R, Gillespie JA. Pretreatment pattern of symptom expression in premenstrual dysphoric disorder. J Affect Disord 2005;85:275-82.  Back to cited text no. 2
Hyde J, Sawyer TF. Estrous cycle fluctuations in aggressiveness of house mice. Horm Behav 1977;9:290-5.  Back to cited text no. 3
MacDonald PC, Dombroski RA, Casey ML. Recurrent secretion of progesterone in large amounts: An endocrine/metabolic disorder unique to young women? Endocr Rev 1991;12:372-401.  Back to cited text no. 4
Reid RL. Premenstrual syndrome. N Engl J Med 1991;324:1208-10.  Back to cited text no. 5
Hartlage SA, Breaux CA, Yonkers KA. Addressing concerns about the inclusion of premenstrual dysphoric disorder in DSM-5. J Clin Psychiatry 2014;75:70-6.  Back to cited text no. 6
Kantero RL, Widholm O. Correlations of menstrual traits between adolescent girls and their mothers. Acta Obstet Gynecol Scand 1977;14 Suppl 14:30-42.  Back to cited text no. 7
Reid RL. Premenstrual syndrome: A time for introspection. Am J Obstet Gynecol 1986;155:921-6.  Back to cited text no. 8
Björn I, Bixo M, Nöjd KS, Nyberg S, Bäckström T. Negative mood changes during hormone replacement therapy: A comparison between two progestogens. Am J Obstet Gynecol 2000;183:1419-26.  Back to cited text no. 9
Mira M, McNeil D, Fraser IS, Vizzard J, Abraham S. Mefenamic acid in the treatment of premenstrual syndrome. Obstet Gynecol 1986;68:395-8.  Back to cited text no. 10
Coffee AL, Kuehl TJ, Willis S, Sulak PJ. Oral contraceptives and premenstrual symptoms: Comparison of a 21/7 and extended regimen. Am J Obstet Gynecol 2006;195:1311-9.  Back to cited text no. 11
Yonkers KA, Brown C, Pearlstein TB, Foegh M, Sampson-Landers C, Rapkin A. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol 2005;106:492-501.  Back to cited text no. 12
Wyatt KM, Dimmock PW, Jones PW, Shaughn O'Brien PM. Efficacy of Vitamin B-6 in the treatment of premenstrual syndrome: Systematic review. BMJ 1999;318:1375-81.  Back to cited text no. 13
Harrison WM, Endicott J, Nee J. Treatment of premenstrual dysphoria with alprazolam. A controlled study. Arch Gen Psychiatry 1990;47:270-5.  Back to cited text no. 14
MacGregor A. Migraine associated with menstruation. Funct Neurol 2000;15 Suppl 3:143-53.  Back to cited text no. 15
Salonen R, Saiers J. Sumatriptan is effective in the treatment of menstrual migraine: A review of prospective studies and retrospective analyses. Cephalalgia 1999;19:16-9.  Back to cited text no. 16
Murray SC, Muse KN. Effective treatment of severe menstrual migraine headaches with gonadotropin-releasing hormone agonist and “add-back” therapy. Fertil Steril 1997;67:390-3.  Back to cited text no. 17
Marjoribanks J, Brown J, O'Brien PM, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev 2013;6:CD001396.  Back to cited text no. 18


  [Table 1]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
Typical History
Article Tables

 Article Access Statistics
    PDF Downloaded483    
    Comments [Add]    

Recommend this journal