premenstrual

Symptoms. Symptoms may begin at the time of ovulation and increase until the menses, or they may appear at ovulation, abate, and then reappear and increase until menses. In some cases they arise only a few days before the onset of menstruation. In true PMS the symptoms cease with the onset of menses or last no more than a few days into the cycle.

Premenstrual syndrome can affect virtually every system of the body and produce behavioral changes that have significant psychosocial impact. Physical symptoms may include headache, vertigo, or paresthesias; common colds, rhinitis, asthma, sinusitis, or sore throat; abdominal bloating, nausea, or food cravings; breast tenderness and engorgement; backache, joint pain, and edema; and others. Psychological or emotional symptoms may include irritability, tiredness with sleep disturbance, mood swings, depression, and altered libido.

Treatment. Successful management of the syndrome is difficult and protocols vary greatly, probably because there is no clear understanding of the causes. Therapies include progesterone therapy, administration of vitamin B₆ daily, and curtailment of intake of sodium, methylxanthines (coffee, tea, and chocolate), and nicotine. Additionally, the patient may be advised to restrict the intake of refined sugar, alcohol, and animal fats. Increasing the intake of vegetable oils may be recommended in order to enhance prostaglandin formation.

Patient Care. A major goal of intervention is the promotion of self-care strategies. For example, the patient is encouraged to keep a menstrual calendar to validate cyclic changes and to give her a sense of purposeful management of her life. She may then plan to avoid stressful events during the time symptoms are present. Counseling can help identify sources of stress and effective mechanisms to deal with stressful situations. Sufficient sleep and rest are needed because fatigue tends to exaggerate the symptoms. Moderate exercise can increase the patient's sense of well-being. A nutritious diet is also helpful, especially the inclusion of foods that are natural sources of the B vitamins and magnesium. The intake of sodium, caffeine, and refined sugar should be limited and alcohol and tobacco avoided.

Severe premenstrual symptoms can seriously disrupt vital human relationships, leading to domestic problems including child abuse and other acts of violence. Health care providers will need to be aware of the psychosocial ramifications of premenstrual syndrome and to facilitate positive coping behaviors, make referrals to agencies prepared to deal with these kinds of problems, and provide support and counseling when indicated.