Premenstrual Tension - Symptoms, Diagnosis & Treatment

PMS (premenstrual syndrome) is the name for the symptoms women can experience in the weeks before their period. Most women have PMS at some ...

PMS (premenstrual syndrome) is the name for the symptoms women can experience in the weeks before their period. Most women have PMS at some point. You can get help if it affects your daily life.

What is Premenstrual Tension?

Premenstrual Tension:- Symptoms, Diagnosis & Treatment

Some women experience certain premenstrual symptoms called premenstrual tension about 7-10 days before the start of menstrual bleeding. These premenstrual symptoms include irritability, malaise, lassitude, headache, gastrointestinal upset like constipation and spasm of colon, feeling of fullness of the breasts and abdomen, frequency of urination etc. There may also be feeling of congestion in the feet and face. In some women these symptoms become exaggerated and form a well marked psychosomatic disorder.

In some of the cases of premenstrual tension water retention can be demonstrated by an increase of body weight up to 5 kilos which is accompanied by pedal edema. This is more marked if the patient has history of phlebothrombosis. The fullness of breasts can be prominent symptom and can be accompanied by breast tenderness. On examination of breasts, there is hardness and lumpy feeling and there is also tenderness. Some women with premenstrual tension suffer from migraine headache which disappear if the woman become pregnant.

The cause or etiology of premenstrual tension is not clear. It is suggested (but not proved) that premenstrual tension may be due to excess production of estrogen and abnormal or disturbance in adrenal function, because there is always an increase of extra-cellular water throughout the body. This is because estrogen is recognized to cause water and sodium retention as seen in carcinoma of prostate, where there is excess production of estrogen. But presence of large amount of estrogen does not always produce water retention as seen in granulosa cell tumor. Adrenal cortical steroids and progesterone (progesterone containing oral contraceptive pills may are well known for their water retention properties) can also cause water retention, so it may not be always due to estrogen excess.

Treatment of Premenstrual Tension

Premenstrual tension is as the name suggests certain symptoms (symptoms include headache, gastro-intestinal upset, irritability, lethargy, constipation, frequency of urination, fullness of breasts and some women experience eruption of acne or pimples) few days preceding menstruation. Treatment of premenstrual tension depends on elimination of extra-cellular fluid by a salt free diet and also by limiting water intake for about 10 days preceding menstruation. The treatment regimens used are:

• Use of diuretics like chlorthiazide 250 mg single dose or saline purgatives for 10-12 days starting at the onset of the premenstrual symptoms until menstruation starts is very successful.
• Use of methyl testosterone 10 mg daily in the last half of the menstrual cycle in certain cases of premenstrual tension and use of large dose of progesterone is useful. But use of progesterone and testosterone can not be explained scientifically because if the theory of water retention as causative factor for premenstrual tension is accepted, than progesterone and testosterone are contra-indicated. 
• For treatment symptoms like breast fullness or congestion adequate breast support and fluid restriction and elimination is required. For treating the premenstrual headache (migraine like) ergotamine tartrate in large dose of maximum 10 mg daily and care should be taken so that the dose does not exceed 10 mg per day otherwise there is danger of serious side effects like peripheral vascular spasm (which is seen with all alkaloid drugs).
• Many women with premenstrual tension suffer from acne on the body and face and also some skin eruption. Unfortunately the treatment of these conditions is unsatisfactory.

The most important factor in premenstrual tension is psychosomatic and it commonly affects women who are highly strung, introspective and neurotic. The headache or breast tenderness is exaggerated into an obsession of serious nervous disease or the woman becomes that she is having cancer. Due to all these the woman becomes short tempered and her family life and social life get disturbed. There may be tendency to suicide due to extreme depression. Study reveals that the female crime is higher during premenstrual phase of the period. These patients should be treated with patience and reassurance. Psychiatric consultation should be advised for these patients.