Premenstrual Syndrome (PMS)
PMS is any unpleasant or uncomfortable symptom during your cycle that may temporarily disturb normal functioning. These symptoms may last from a few hours to many days, and the types and intensity of symptoms can vary in individuals.
Premenstrual Dysphoric Disorder (PMDD) is a much more severe form of PMS which affects approximately 3%-8% of women of reproductive age. PMDD requires treatment by a physician. According to the American College of Obstetricians and Gynecologists, nearly 85% of women experience at least one common symptom associated with PMS during their reproductive years. An estimated 5% have symptoms so extreme they are disabled by the condition.
Although each individual may experience symptoms differently, the most common symptoms of PMS can include any of the following:
- Psychological symptoms (depression, anxiety, irritability)
- Gastrointestinal symptoms (bloating)
- Fluid retention (swelling of fingers, ankles and feet)
- Skin problems (acne)
- Muscle spasms
- Heart palpitations
- Vision problems
- Eye infections
- Decreased coordination
- Diminished libido (sex drive)
- Changes in appetite
- Hot flashes
Simple modifications in lifestyle can help eliminate or reduce the severity of symptoms, including:
- Exercising 3 to 5 times each week
- Eating a well-balanced diet that includes whole grains, vegetables and fruit, and a decreasing salt, sugar, caffeine and alcohol intake
- Getting adequate sleep and rest
Amenorrhea is characterized by absent menstrual periods for more than three monthly menstrual cycles. There are two types of amenorrhea:
Types of Amenorrhea
- Primary amenorrhea: Menstruation does not begin at puberty.
- Secondary amenorrhea: Normal and regular menstrual periods which become increasingly abnormal and irregular or absent. This may be due to a physical cause typically of later onset.
Amenorrhea can occur for a number of reasons as part of the normal course of life, such as pregnancy, breast-feeding or menopause. Or, it may occur as a result of medications or a medical problem including:
- Ovulation abnormality
- Birth defect, anatomical abnormality or other medical condition
- Eating disorder
- Excessive or strenuous exercise
- Thyroid disorder
If at least three consecutive menstrual periods are missed or if you’ve never had a menstrual period and are 16 years or older, it is important to see a healthcare professional. As with any condition, early diagnosis and treatment is very important.
Dysmenorrhea is characterized by severe and frequent menstrual cramps and pain associated with menstruation. The cause of dysmenorrhea is dependent on if the condition is primary or secondary. With primary dysmenorrheal, women experience abnormal uterine contractions resulting from a chemical imbalance in the body. Secondary dysmenorrhea is caused by other medical conditions, most often endometriosis. Other possible causes may include:
- pelvic inflammatory disease (PID)
- uterine fibroids
- abnormal pregnancy (i.e., miscarriage, ectopic)
- infection, tumors, or polyps in the pelvic cavity
Any woman can develop dysmenorrhea, but those who are at an increased risk include:
- Those who consume excessive alcohol during their period
- Women who are overweight
- Women who started menstruating before the age of 11
The most common symptoms may include:
- Cramping or pain in the lower abdomen
- Low back pain or pain radiating down the legs
Menorrhagia is the most common type of abnormal uterine bleeding and is characterized by heavy and prolonged menstrual bleeding. In some cases, bleeding may be so severe that daily activities are disrupted.
Other types of this condition, also called dysfunctional uterine bleeding, may include:
- Polymenorrhea: Too frequent menstruation.
- Oligomenorrhea: Infrequent or light menstrual cycles
- Metrorrhagia: Any irregular, non-menstrual bleeding as in bleeding which occurs between menstrual periods
- Postmenopausal bleeding: Any bleeding that occurs more than one year after the last normal menstrual period at menopause
There are several possible causes of menorrhagia, including:
- Hormonal imbalance
- Pelvic inflammatory disease (PID)
- Uterine fibroids
- Abnormal pregnancy; i.e., miscarriage, ectopic (tubal pregnancy)
- Infection, tumors or polyps in the pelvic cavity
- Certain birth control devices; i.e., intrauterine devices (IUDs)
- Bleeding or platelet disorders
- High levels of prostaglandins (chemical substances used to control muscle contractions of the uterus)
- High levels of endothelins (chemical substances used to dilate blood vessels)
- Liver, kidney or thyroid disease
Typical symptoms of menorrhagia are when a woman has soaked through enough sanitary napkins or tampons to require changing every hour, and/or a woman’s menstrual period lasts longer than 7 days in duration. Other common symptoms include spotting or bleeding between menstrual periods, or spotting or bleeding during pregnancy.
A diagnosis can only be certain when the physician has ruled out other menstrual disorders, medical conditions or medications that may be causing or aggravating the condition.
Other diagnostic procedures may include:
- Blood tests
- Pap test
- Ultrasound: An imaging technique which uses high-frequency sound waves to create an image of the pelvic organs.
- Magnetic resonance imaging (MRI): A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of the reproductive organs.
- Laparoscopy: A minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic and abdomen area, the physician can often detect abnormal growths.
- Hysteroscopy: A visual examination of the canal of the cervix and the interior of the uterus using a hysteroscope inserted through the vagina.
- Biopsy (endometrial): Tissue samples are removed from the lining of the uterus with a needle or during surgery to determine if cancer or other abnormal cells are present.
- Dilation and curettage (D&C): A common gynecological surgery which consists of widening the cervical canal with a dilator and scraping the uterine cavity with a curette – a spoon-shaped surgical tool used to remove tissue.
Your doctor may suggest a psychiatric evaluation to rule out other possible conditions, or ask you to track your symptoms in a journal to better assess the timing, severity, onset and duration of symptoms.
A specific treatment plan will be determined by your doctor based on factors such as:
- Your age, overall health and medical history
- Extent of the condition
- Possible cause of the condition
- Current symptoms
- Your tolerance for specific medications, procedures or therapies
Treatments for menstrual disorders
Discussing your menstrual disorder symptoms with your doctor can help determine what type of treatments can best reduce or relieve your symptoms, including:
- Prostaglandin inhibitors
- Hormone supplements
- Oral contraceptives
- Vitamin or mineral supplements
- Dietary modifications
- Regular exercise