Pathophysiology of Premenstrual Syndrome
Premenstrual syndrome is emotional and physical symptoms which ensue between one to two weeks prior to a woman's period. It impacts a woman’s behavior, physical health, and emotions before her menses because the levels of progesterone and estrogen rise during particular periods of the month and a rise in the levels of these hormones can result in irritability, anxiety, mood swings as illustrated in Tracey. Ovarian steroids associated with premenstrual symptoms. Moreover, serotonin is among the gut and brain chemicals which impacts thoughts, emotions, and moods.
In Tracey’s case, she also experiences physical changes such as tiredness and breast tenderness, behavioral changes such as irritability, and emotional changes such as anger. It is worthwhile noting that these symptoms can manifest themselves in late, mid or early luteal stage. Nevertheless, the symptoms occur in Tracey one week or three days before her menses, meaning she experiences early Premenstrual syndrome. Premenstrual syndrome is usually triggered or prompted by hormonal events which ensue after ovulation (Walsh et al., 2015). The symptoms of Premenstrual syndrome (PMS) are associated with the ovarian production of progesterone. The progesterone metabolites formed by the ovarian corpus luteum impasse to the gamma-amino butyric acid receptor membrane particularly the neurosteroid binding site altering its configuration (Imai et al., 2015), therefore, making it resistant to additional activation and eventually reducing central gamma-amino butyric acid mediated inhibition. In the same token, the progesterone in certain hormonal contraceptives can as well adversely impact the gamma-aminobutyric acid system.
Common Causes of Premenstrual Syndrome
It is important to note that the exact causes of the premenstrual syndrome have not been established, however, particular factors can contribute to the disorder. According to Safari et al. (2015), chemical changes in the brain are one of the factors attributed to premenstrual syndrome. Serotonin fluctuation, a neurotransmitter (brain chemical) is believed to play a significant role in mood swings, therefore, triggers premenstrual syndrome symptoms. Inadequate serotonin amounts can result in sleep problems, food cravings, fatigue as well as premenstrual depression. Hormonal changes such as progesterone level during the menstrual cycle also acts as a crucial factor causing the premenstrual syndrome.
Besides, inflammation is another factor attributed to Premenstrual Syndrome (PMS). Research indicates that Premenstrual Syndrome sufferers have a significant level of inflammatory markers. Reduction of inflammation is important in negating the Premenstrual Syndrome symptoms. In Tracey, inflammation can be driven by gut imbalances, urinary tract infection, and inflammatory diet or foods like snacks. Ovarian cyst removal may be another cause of Premenstrual Syndrome in Tracey. The non-existence of ovarian cyst results in fluctuation in the production of estrogen and progesterone leading to symptoms such as breast tenderness. In Tracey’s case, it seems the progesterone was blunted in the luteal stage by high cortisol; making the ratio between progesterone and estrogen abnormally high thus resulting in Premenstrual Syndrome symptoms in one week before her menstrual period. Finally, Tracey’s alcohol consumption, smoking and high sodium (through the consumption of salty snacks) exacerbated symptoms such as abdominal bloating (Brahmbhatt et al., 2017). Most importantly, Premenstrual Syndrome occurs in women between ages 20s to early 40s. Tracey being 38 years old stands a better chance of experiencing the condition.
Difference between Clinical Manifestations of Polycystic Ovary Syndrome and Premenstrual Syndrome
Polycystic ovary syndrome refers to a set of certain symptoms in females as a result of elevated or eminent androgens. Its signs and symptoms include pelvic pain, acne, excess facial hair, heavy periods, no or irregular menstrual period, and patches of velvety, thick, darker skin. According to Ryu and Kim et al. (2015), women with polycystic ovary syndrome develop oily skin or acne due to hormone changes. They also experience sleeping difficulties and feel tired all the time. Carmina, Fruzzetti & Lobo (2018), argue that polycystic ovary syndrome is associated with conditions such as mood disorders, heart disease, obstructive sleep apnea, obesity, and type 2 diabetes. Its diagnosis is based on findings such as ovarian cysts, high levels of androgen, and non-occurrence of ovulation. It is important to note that many of the women having polycystic ovary syndrome have insulin resistance, and it the elevated insulin levels which causes or contribute to the abnormalities.
On the other hand, premenstrual syndrome is associated with the presence of both behavioral and physical symptoms which repeatedly occur in the second half of the menstrual cycle. Premenstrual syndrome is characterized by signs and symptoms such as internal tension, irritability, and anger. It usually occurs during five days prior to the inception of menses and may be present in almost three consistent menstrual cycles. Tracey can be said to suffer from premenstrual syndrome because she experiences the symptoms from three days to one week before her period. Other symptoms of polycystic ovary syndrome include bloating, depression, and breast pain which were encountered in Tracey. Abnormally high progesterone to estrogen ratio or progesterone deficiency during the luteal stage is the primary cause of the premenstrual syndrome.
Common Therapies for Premenstrual Syndrome and the Lifestyle Changes to Help with Premenstrual Syndrome
Notably, for many females, lifestyle changes like smoking and alcohol cessation, and exercising can aid relieve premenstrual syndrome symptoms. However, depending on the severity of the symptoms a doctor may prescribe certain therapies including antidepressant. Dimmock (2017), portends that selective serotonin inhibitors such as paroxetine (pexena, Paxil), fluoxetine (Sarafem, Prozac), and sertraline play a critical role in decreasing mood symptoms. Selective serotonin inhibitors are the best therapy for the severe premenstrual syndrome. Secondly, non-steroidal anti-inflammatory drugs such as Motrin IB and Advil can ease breast discomfort and cramping. Thirdly, diuretic is another therapy of Premenstrual Syndrome. Limiting salt intake and exercising are not sufficient to reduce bloating, swelling of Premenstrual Syndrome and weight gain. Taking diuretics or water pills such as Spironolactone can aid the body shed off fluid via the kidney. Lastly, hormonal contraceptives treat Premenstrual Syndrome by stopping ovulation.
The first lifestyle change in managing PMS is the development and maintenance of a healthy lifestyle; including possibly taking vitamins, managing stress, exercising, mineral supplements such as calcium, and eating a well-balanced diet. Individuals need to eat a diet with low saturated fats and rich in vegetables, fruits, and whole grains. In the same vein, women need to cease consumption of salt, alcohol, caffeine (Kaushik et al., 2017), and sugary foods about two weeks prior to their menstruation period and drink plenty of fluid including water. Women also need to reduce stress because high levels of stress tend to worsen premenstrual syndrome symptoms. Reduction of tress should also be accompanied by relaxation or more rest.
Brahmbhatt, S., Sattigeri, B. M., Shah, H., Kumar, A., & Parikh, D. (2017). A prospective survey study on premenstrual syndrome in young and middle aged women with an emphasis on its management. International journal of research in medical sciences, 1(2), 69-72.
Carmina, E., Fruzzetti, F., & Lobo, R. A. (2018). Features of polycystic ovary syndrome (PCOS) in women with functional hypothalamic amenorrhea (FHA) may be reversible with recovery of menstrual function. Gynecological Endocrinology, 34(4), 301-304.
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.
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Kaushik, D., Sheetal, D., Sharma, L., & Ajmera, P. (2017). Pre menstrual syndrome among females.
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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..
Walsh, S., Ismaili, E., Naheed, B., & O'Brien, S. (2015). Diagnosis, pathophysiology and management of premenstrual syndrome. The Obstetrician & Gynaecologist, 17(2), 99-104.