Today’s Subject: Premenstrual syndrome (PMS)

Now this is a subject that I am sure both guys and gals can relate to, am I right?
I remember awhile  ago when I was doing research on this topic I met a doctor who specialises in female reproduction, he told me that if a female was at her optimal level of health and wellness then PMS or PMT would not occur!!
So what exactly is the driving force behind PMS? Today we find out.
PMS

Premenstrual syndrome or PMS is also referred to a premenstrual tension (PMT). It is an umbrella term used to describe the physical and emotional symptoms which many females experience prior to and as a result of menstruation. Up to 85% (Melmed et al 2011) of the female population of reproductive age will suffer from PMS, with up to 30% (Panay 2012) suffering from severe symptoms, when these symptoms occur it is usually classed as premenstrual dysphoric disorder (PMDD), a more severe form of PMS.
With over 200 different symptoms PMS is a very broad disorder and symptoms range from being very mild to quite severe, even to a point where medical intervention is required.
In the past PMS was dismissed as a form of hysteria and females were forced to suffer in silence, but with such a large portion of the female populations suffering with this disorder research as advanced in this area and PMS is now becoming better understood than most female conditions.

The cause of PMS is still not completely understood but changes in hormone levels throughout the menstrual cycle play an important role since symptoms commonly occur during the luteal phase of the female 28 day reproductive cycle. Progesterone, oestrogen and allopreganalone are the three hormones believed to play a major role in the cause of PMS.
Neurotransmitters and the chemical changes in the brain are also involved. Murotransmitters such as serotonin, glutamate, Gamma- Aminobutyric acid (GABA), and beta endorphins.
Recently the idea that a genetic factor is involved with the involvement of oestrogen receptor alpha (ER-α) gene being variant (Panay 2009), however sample sizes in studies have been too small and larger scale research needs to be conducted to back up these findings.
Some research as hypothesised that PMS has become more prevalent in the previous 100 years due to the lack of time the average female is involved in reproduction and childbearing (Cunningham et al 2009). Females would experience multiple pregnancies and lactation was the main form of infant survival so particular hormones such as prolactin supress GnRH which stimulates luteinizing hormone and follicle stimulating hormone as well as reduces oestrogens and progesterone, causing ovulation suppression in order to ensure premature pregnancy did not occur.
As well as inadequate nutrition this caused extended periods of amenorrhea which would protect females from long durations of cyclic menstruation with fluctuating oestrogen and progesterone which are linked to PMS.

The absence of PMS before puberty, during pregnancy and post menopause supports the idea that cyclical ovarian activity has an impact of the disorder.
Sexual receptivity is heightened and aggression is reduced prior to and during the ovulatory phase in the female 28 day reproductive cycle. The luteal phase is when majority of females will experience PMS or PMT symptoms suggesting that gonadal steroids are involved in the pathophysiology of PMS.
Prior to and during the ovulatory phase the corpus luteum is established and produces higher levels of progesterone, and lower levels of oestrogen, particularly oestradiol which prepare the uterus for implantation and possible fertilisation. When fertilisation does not occur the corpus luteum degenerates and levels of progesterone as well as oestradiol begin to fall. This occurs during the luteal phase and is believed to be responsible for some of the physical symptoms of PMS and PMDD. However this effect also as an emotional component.
Oestrogen has an influence on serotonin levels. Where progesterone is considered to have a link to central nervous system changes in GABA and the interaction with GABA receptors. Allopreganalone is a metabolite of progesterone, and is found to be lower in symptomatic females and in asymptomatic females (Cunningham 2009). Allopreganalone and GABA receptors interact but symptomatic females are less responsive suggesting less sensitivity. This creates an inadequate response to stresses and increases the prospect of emotional reactions.
Central neurotransmitters play an important role in the mood and behavioural symptoms of PMS and PMDD.
Serotonin is a neurotransmitter of the central nervous system and is involved in mood and behaviour regulation. Due to the fact that oestrogen helps to regulate serotonin levels, when oestrogen levels begin to fall serotonin levels fall as well. This leads to changes in mood and behavioural activity, which explains the symptoms that occur in regards to PMS and PMDD during the later stages of the luteal phase.
Gamma-Aminobutyric acid is also an inhibitory neurotransmitter of the central nervous system and is responsible for reducing neuronal excitability, which helps reduce anxiety, it is also responsible for regulating muscle tone, a possible explanation as physical symptoms experienced during progesterone withdrawal during the luteal phase.
Progesterone and allopreganalone have an influence of GABA and its receptors. With the withdrawal of progesterone during the luteal phase, this reduces the amount of GABA available within the system, causing both physical and emotional symptoms.
Glutamate is also a neurotransmitter for the central nervous system and a precursor for GABA and studies have shown that levels decrease during the luteal phase of the female 28 day reproductive cycle.
Beta-Endorphins is an endogenous opioid neuropeptide found in the central and peripheral nervous systems and works as an analgesic to numb or dull pain in the body. Oestrogen levels help influence bata-Endorphin levels but oestrogen withdrawal during the luteal phase reduces the amount of beta-Endorphins in the body and is responsible for both physical and emotional symptoms of PMS and PMDD.

The disease manifestations tend to differ and can either be physical or emotional. There are over 200 symptoms of PMS and they vary from very mild to rather severe.
Physical symptoms include fluid retention and swelling, weight gain, joint and muscle pain and aches, abdominal pain bloating and discomfort, breast tenderness, headaches, fatigue, insomnia, nausea, acne, changes in appetite, constipation and diarrhoea to name a few.
Emotional symptoms include but are not limited to mood fluctuations, irritability, anxiety and depression, difficulty in concentration, emotional or tearful, and social withdrawal.

PMS is an umbrella term used to describe a range of symptoms which affect up to 85% of the female population of reproductive age. It has over 200 symptoms which differ in severity. A major component of PMS is hormonal and chemical, with possibility of a genetic factor coming into play. However like most female conditions there is still more research needed in order to conclude clear causes.

Aly Curd

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