Premenstrual Syndrome
The premenstrual syndrome (PMS) refers to a variety of symptoms which recur in the same phase of the menstrual cycle. These generally make their appearance two to seven days before the onset of menstruation and are relieved once the menses start.

Approximately 40% of menstruating women suffer from premenstrual tension and it occurs mostly in women over 30 years of age. In some women, the onset of symptoms seems to coincide with ovulation and may then persist until menstruation commences. In some rare cases, relief from the premenstrual syndrome may be obtained only with the cessation of the menstrual flow.

The onset of this syndrome is abrupt, generally with a headache which is often accompanied by vomiting. A general feeling of depression and irritability permeate the entire experience. What is worse, these symptoms intensify progressively, making the last day of the PMS the worst.

Tension headaches are common during this period, but in some cases, migraines attacks occur with severe pain and vomiting. The patient suffers from breast tenderness, which is sometimes so severe that it is almost unbearable. There may also be abdominal bloating, accompanied by edema of the ankles and hands. Some women resort to dieting to get rid of the abdominal bloating but this only leads to fatigue and depression. Others may experience a craving for sweet foods.

Some of the less common symptoms are the exacerbation of epilepsy dizziness, backache, hoarse voice, greasy hair, acne and allergic reactions.

Patients suffering from premenstrual tension may show a gain of weight of one kg or more in the later part of the menstrual cycle due to salt and water retention. The retention of fluid is partly due to ovarian steroids, but there is also an increased output of an anti-diuretic hormone from the posterior pituitary gland.

There is no specific laboratory diagnosis of the premenstrual syndrome. The problem can be diagnosed on the basis of past history showing a clear, recurrent relationship between a stage of the menstrual cycle and the onset of symptoms as well as the coincidence of relief with the start or cessation of menstruation. The patient may maintain a personal diary about her symptoms and feelings during those days. The record should be kept for at least three cycles.

The causes behind the premenstrual syndrome still remain unexplained. Some authorities believe that deficiency of hormone progesterone may result in PMS but this has not yet been satisfactorily proved. Emotional stress can often contribute to the symptoms, and the social relationship of the patient needs to be reviewed.

A team of researchers at Sinai Hospital in Baltimore and John Hopkins University School of Medicine, London, through carefully controlled studies concluded that dietary deficiencies particularly that of vitamin E and vitamin B6 or pyridoxine are the most common causes of PMS.