Does Premenstrual Syndrome Really Exist?

In severe cases, PMS can be similar to depression in its effects. Although there are no medications that can completely prevent PMS, many women have found relief through making lifestyle changes and taking specific medications.

What is premenstrual syndrome?

Premenstrual syndrome, commonly known as PMS, refers to a collection of psychological discomforts and physical symptoms that typically occur on a regular basis prior to menstruation. PMS typically ceases once a woman enters menopause, which is marked by the permanent cessation of menstruation.

At present, most experts recognize PMS as a legitimate condition that many women experience at some point in their lives. However, it is challenging to determine the exact number of women affected as estimates can vary among specialists.

British surveys suggest that around 47.8% of women of reproductive age experience PMS at some point in their lives. On the other hand, the US Office on Women’s Health (OWH) estimates that this issue affects as many as 90% of American women.

PMS most frequently affects women in their 30s, although some may experience it before their first menstrual cycle. It is typically reported that PMS gradually weakens as a woman approaches menopause.

Symptoms of PMS can vary significantly from woman to woman. While some may experience a combination of psychological and physical symptoms, others may only encounter one type of issue – either psychological or physical.

How do women with PMS feel?

Approximately 20% of women who suffer from PMS experience it so severely that it can significantly disrupt their ability to perform daily activities such as work or study. This condition is referred to as premenstrual dysphoric disorder (PMDD).

Although specialists consider PMDD to be a hormonal disorder rather than a mental one, its manifestations can resemble severe depression. In addition to body aches and digestive disorders, some women feel so overwhelmed, worthless, and broken that they even contemplate suicide.

Distinguishing PMS from other medical conditions can be challenging since the physical symptoms of PMS may resemble those of irritable bowel syndrome and thyroid diseases, while the psychological symptoms may overlap with those of anxiety disorders, depression, and chronic fatigue syndrome.

Unlike hormonal disorders and mental health conditions, PMS is always associated with the menstrual cycle. A diagnosis of PMS is typically confirmed if uncomfortable symptoms appear five days before menstruation and continue for at least three consecutive menstrual cycles, ending no more than four days after the onset of menstruation.

Why does PMS occur?

The exact cause of PMS is not yet fully understood. However, one theory suggests that the symptoms are related to fluctuations in the levels of female sex hormones in the body.

After ovulation, the level of progesterone hormone in the female body begins to increase, which prepares the body for pregnancy. Some studies suggest that this increase in progesterone leads to a decrease in the level of serotonin, a neurotransmitter that affects mood and well-being. This decrease in serotonin can result in a decline in a person’s mood and well-being, similar to what happens in depressive disorders.

The validity of this hypothesis is further supported by the fact that some women with PMS have found relief from antidepressants belonging to the selective serotonin reuptake inhibitor (SSRI) group, which are commonly prescribed to treat depression

However, this hypothesis faces a problem: women with PMS and those without PMS have no difference in their blood progesterone levels before the start of menstruation. It is possible that some women are simply more sensitive to the hormone’s effects than others.

The hormonal hypothesis alone cannot fully explain why some women experience abdominal pain before menstruation, while others do not. One possibility is that in women who are sensitive to the increase in progesterone levels, the hormone may reduce the concentration of calcium in the blood. Calcium plays a role in controlling the smooth muscles of the intestines, and its deficiency can lead to digestive problems such as abdominal pain

Despite this, there is currently no concrete evidence to support the theory that PMS is directly caused by a deficiency in calcium levels. Furthermore, studies have shown that taking calcium and vitamin D supplements did not effectively treat PMS symptoms in women.

How to Improve Well-Being with PMS?

Two treatment methods: lifestyle modification and medication therapy.

Change of lifestyle. There is evidence that symptoms of PMS can be alleviated by a healthy lifestyle.

When women quit smoking and adopt healthier lifestyle habits, such as consuming less alcohol, exercising regularly, eating a balanced diet, and getting adequate sleep, they may experience a reduction in PMS symptoms, according to research.

Additionally, experts suggest that aerobic physical exercise can alleviate mild mood swings and abdominal pain. Iranian female students who suffered from PMS reported a significant reduction in headaches, nausea, gastrointestinal disorders, and edema after exercising for only 20 minutes, three times a week for eight weeks, compared to a group of PMS female students who did not exercise.

For women with moderate to severe PMS symptoms that affect their daily life, lifestyle modifications may not be enough and additional treatment may be necessary.

Two methods for relieving PMS symptoms are taking medication and using non-medicinal methods.

To stabilize the fluctuations of female sex hormones, women can take combined oral contraceptives (COCs) in tablet form. COCs can help “level out” the levels of female sex hormones in the blood, which can prevent not only pregnancy but also PMS. Women should consult with a gynecologist to choose the right COC that will have no side effects.