Premenstrual Syndrome: Causes, Symptoms, And Treatments

These symptoms have been HIGHLY repetitive and predictable for the last three menstrual periods, usually, occur three days or one week before menses. Her menstrual cycle has been remarkably predictable for the last two years. However, her symptoms aggravated just before menstruation.

She had severe urinary tract infections 13 years ago, and her ovarian cyst was removed eight years ago. She was referred to the Family Planning Clinic based in Brisbane by her obstetrician and gynaecologist Dr Sarah Johnson.

Questions

1. Explain the pathophysiology of Premenstrual Syndrome and relate Tracey’s symptoms to its pathophysiology?
2. Discuss the common causes of Premenstrual Syndrome.
3. Describe the difference between clinical manifestations of Polycystic Ovary Syndrome and Premenstrual Syndrome.
4. Outline the most common therapies for Premenstrual Syndrome and discuss the lifestyle changes to help with PMS syndrome

What is Premenstrual Syndrome?

1) Premenstrual syndrome (PMS) is conditions that influence the behaviour and emotions of a woman during certain days of the menstrual cycle. PMS usually occurs during the luteal phase of the menstrual cycle. During the luteal phase, the hormones from the ovary cause lining of the uterus to be thick and spongy (Ryu & Kim, 2015). During this time frame, progesterone hormone increase in the body while the level of estrogen exponentially decreases in the body.  The hormonal shift from the estrogen to progesterone may cause some of the Pre-menstrual syndrome (Naheed et al., 2017). A significant number of women experience symptoms such as diarrhea, nausea, anger irritation, excessive hunger, excessive hunger issues anxiety and discomfort.

This case study represents a premenstrual syndrome of a 38-year-old married woman who was admitted to the Belmont private hospital. She complained that she was exhibiting few symptoms such as anger issues, tenderness of breast, tiredness, nausea, acne problem and abnormal blotting. These all syndromes are related to the premenstrual syndrome since these symptoms are a hormone influenced syndrome. Abnormal blotting observed due to the progesterone hormone which decreases the bile production and food moves slowly through the intestine (Khayat et al., 2015). The hormonal cycle also controls the level of serotonin and individuals to exhibit the anger issues and other mood changes. The patient stated that she had a urinary tract infection and it is related to the premenstrual cycle since estrogen is an anti-inflammatory hormone which decreased during the PMS (Naheed et al., 2017). Moreover, she had an ovarian cyst removed which is related to the premenstrual syndrome since progesterone and estrogen misbalance.

2) Premenstrual syndrome is a group of behavioral disturbance experienced by every woman. Approximately 85% of the women suffer the premenstrual syndrome around the globe (Dimmock et al., 2017). The most of the common cause of premenstrual syndrome is a hormonal imbalance. In premenstrual syndrome, the progesterone level increases and estrogen level decreases. The hormonal imbalance causes the PMS. Moreover, Hormones also influences the neurotransmitter of the brain which gives rise to the premenstrual syndrome (Craft, Gordon & Tiziani 2014).Fluctuation of serotonin or insufficient serotonin give rise to the premenstrual syndrome. Heavy smoking of cigarette and drinking of alcohol can give rise to the premenstrual syndrome. Heavy intake of caffeine frequently is considered as the common cause of premenstrual syndrome (Bryant & Knights, 2014).  Women who do not involve themselves in any physical activity give rise to the premenstrual syndrome. Moreover, those women who are obese and live a stressful life can give rise to premenstrual syndrome (Safari et al., 2015). Subsequently, stressful life gives rise to the premenstrual syndrome (Heydari et al., 2018). Depression can be one of the causes of premenstrual syndrome since depression and emotional distress causes the change of chemicals in brain and leads to the premenstrual syndrome. Besides, those people consume the diet that contains less amount of vitamin and mineral can give rise to the symptoms of premenstrual syndrome (VanMeter, VanMeter & Hubert 2016). Consequently, they experienced specific symptoms such as back pain, abnormal blotting, anxiety and other health issues (Heydari et al., 2018)..

Symptoms of Premenstrual Syndrome

3) Polycystic ovary syndrome is considered as the common heterogeneous endocrine disorder that majority of the women around the globe experience in their existence.  However, there are few significant differences between polycystic ovary syndrome and premenstrual syndrome. The typical clinical manifestation of the polycystic ovary syndrome women seeks care for are the irregular menstrual cycle, excessive hair growth and fertility problem (Sorouri et al., 2015). Menstrual disturbance mainly observed due to irregular ovulation or failure of ovulation in women. Related issues are including difficulty in getting pregnant, excessive hair growth, chest and buttocks, unusual weight gain. Women with premenstrual ovary syndrome also give rise to the other health risks such as diabetes, depression and high blood pressure.

On the other hand, premenstrual syndrome is a familiar condition in many women. The clinical manifestation of premenstrual syndrome include backaches, blotting due to excessive fluid retention, change of appetitive, craving for salty food and pain, constipation and diarrhea Many women experience psychological changes such as agitation, anger, depression, feeling lonely and hopeless. Skin problem also observed due to the hormonal fluctuation in body before menstrual cycle. Women usual feel the abnormal blotting and nausea and acne. According to Australian bureau of statistics, approximately 85 % of women in Australia experience the symptoms of premenstrual syndrome (Sorouri et al., 2015). Although, premenstrual syndrome and polycystic ovary syndrome are clinically different but women with polycystic ovary syndrome often experience few of the symptoms of premenstrual syndromes (Safari et al., 2015).

4) There are many therapies and principles which should be used to manage the symptoms of premenstrual syndrome in women. Systemic reviews and empirical reviews along with randomized trail control reported that cognitive behavioral therapy is the first line therapy to manage the symptom of premenstrual syndrome. In one trial, women were randomized to a group for instructing cognitive behavioral therapy and non-specific behavioral techniques (Safari et al., 2015). That study suggested that approximately 85% of the women responded to behavioral therapy and significant reduction of the symptoms observed. Cumulative studies indicated that cognitive therapy such as educating patients about the signs with the effective verbal communication could effectively reduce the symptoms of premenstrual symptoms. Acquiring the knowledge about the premenstrual syndrome and behavioral changes related to the syndrome help individual (Safari et al., 2015).. One study suggested that second line therapy such information focused therapy leads to a substantial reduction of the symptoms’. Moreover, other psychological approaches such as relaxation technique proved to be an effective way to relieving symptoms’ of premenstrual syndrome.

A large number of effective treatments and change of lifestyle has specific benefits to manage the symptoms of the premenstrual syndrome. Dietary restrictions are often recommended to eliminate the physical and psychological symptoms of premenstrual syndrome. The most common nutritional recommendation is the increase in consumption of carbohydrate has been proved to be adequately studied in one randomized control trial (Naheed et al., 2017).. Women with the syndrome of premenstrual syndrome often encourage increasing the physical activity. The drugs are used to treat the syndromes are ibuprofen, antidepressant such as  Zoloft , Paxil and Effexo (Safari et al., 2015)..

References

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Craft, Gordon & Tiziani (2014), 2nd edn, Understanding Pathophysiology - ANZ adaptation, Mosby, Elsevier, Australia. retrieved from: https://doi.org/10.1089/acm.2016.0302

Dimmock, P. W., Wyatt, K. M., Jones, P. W., & O'Brien, P. M. (2017). Efficacy of selective

serotonin-reuptake inhibitors in premenstrual syndrome: a systematic. Retrieved from : https://pdfs.semanticscholar.org/b104/c2891599f8de459712f387288ff369a1f009.pdf

Heydari, N., Abootalebi, M., Jamalimoghadam, N., Kasraeian, M., Emamghoreishi, M., & Akbarzadeh, M. (2018). Investigation of the effect of aromatherapy with Citrus aurantium blossom essential oil on premenstrual syndrome in university students: A clinical trial study. Complementary Therapies in Clinical Practice, 32, 1-5. Retrieved from : https://doi.org/10.1016/j.ctcp.2018.04.006

Khayat, S., Fanaei, H., Kheirkhah, M., Moghadam, Z. B., Kasaeian, A., & Javadimehr, M. (2015). Curcumin attenuates severity of premenstrual syndrome symptoms: A randomized, double-blind, placebo-controlled trial. Complementary therapies in medicine, 23(3), 318-324. Retrieved from : https://doi.org/10.1016/j.ctim.2015.04.001

Naheed, B., Kuiper, J. H., Uthman, O. A., O'Mahony, F., & O'Brien, P. M. S. (2017). Non-contraceptive oestrogen-containing preparations for controlling symptoms of premenstrual syndrome. Cochrane Database of Systematic Reviews, 3, CD010503. DOI: 10.1002/14651858.CD010503.pub2.

Ryu, A., & Kim, T. H. (2015). Premenstrual syndrome: a mini review. Maturitas, 82(4), 436-440. Retrieved from : https://doi.org/10.1016/j.maturitas.2015.08.010

Safari, T., Manzari Tavakoli, A. R., Kheyr Khah, B., Saeedi, H., & Mahdavinia, J. (2015). The relationship between premenstrual syndrome with anxiety, depression and changes in social relations of women in Kerman University of Medical Sciences. Report of Health Care, 1(4),139-141. Retrieved from :https://jrhc.miau.ac.ir/article_2703_458472a50ea72debe934dabf7f5961c7.pdf

Sorouri, Z. Z., Sharami, S. H., Tahersima, Z., & Salamat, F. (2015). Comparison between unilateral and bilateral ovarian drilling in clomiphene citrate resistance polycystic ovary syndrome patients: a randomized clinical trial of efficacy. International journal of fertility & sterility, 9(1), 9. Retrieved from: doi:  10.22074/ijfs.2015.4202

VanMeter, KC, VanMeter, WG & Hubert, RJ 2nd edn (2016). Microbiology for the healthcare professional, Mosby, Elsevier. Missouri, USA  Retrieved from : https://evolve.elsevier.com/cs/product/9780323320924?role=student