Mood swings premenstrual syndrome

Premenstrual syndrome (PMS) is featured by a cluster of mild to severe physical or emotional symptoms that mainly begin during the luteal phase of the menstrual cycle. Symptoms should disappear within 4-5 days of the onset of menses and be severe enough to interfere with normal and daily function(Choi et al.,1997). The severe or adverse phase of PMS is the Premenstrual Dysphoric Disorder (PMDD), which differs from PMS in respect to intensity of symptoms, predominance of mood symptoms, and the key function impairment.Premenstural syndrome associated with the mensturation is a commonly found symptom (Fig:1). The most common symptoms are mainly tension, irritability, hostility, depression, anxiety, mood swings, sleep changes, breast tenderness, and abdominal bloating (Dalton et al.,1994)(Fig:2). The physiopathology of PMS has yet to be fully clarified and not understood well. Several biological theories have been proposed as the cause of this syndrome and may include the effect of progesterone on neurotransmitters such as serotonin, opiods, catecholamine and GABA

1. Mood Swings of Women: A Premenstrual Syndrome BY SREEREMYA.S FACULTY OF BIOLOGY

2. INTRODUCTION Premenstrual syndrome (PMS) is featured by a cluster of mild to severe physical or emotional symptoms that mainly begin during the luteal phase of the menstrual cycle. Symptoms should disappear within 4-5 days of the onset of menses and be severe enough to interfere with normal and daily function(Choi et al.,1997). The severe or adverse phase of PMS is the Premenstrual Dysphoric Disorder (PMDD), which differs from PMS in respect to intensity of symptoms, predominance of mood symptoms, and the key function impairment.Premenstural syndrome associated with the mensturation is a commonly found symptom (Fig:1). The most common symptoms are mainly tension, irritability, hostility, depression, anxiety, mood swings, sleep changes, breast tenderness, and abdominal bloating (Dalton et al.,1994)(Fig:2). The physiopathology of PMS has yet to be fully clarified and not understood well. Several biological theories have been proposed as the cause of this syndrome and may include the effect of progesterone on neurotransmitters such as serotonin, opiods , catecholamine and GABA,

3. About 30% to 60% of menstruating women experience mild to moderate form of PMS, and 4% to 15% experience severe PMS ( Clerkner et al., 1998). PMS leads to capacity loss of the individual and to such psychological problems as anxiety, depression, committing suicide; and therefore results in decrease in quality of life. In fact, PMS influences not only women but also the main family and the society. Lifetime history of the anxiety or mood disorders has been reported in over half of women presenting with PMS (Condon, 1993). The incidence of the depression among patients with PMS is greater than healthy women. Different reports indicated that irritability, impulsivity, anger, anxiety, tension and nervousness are much more prevalent in premenstrual period and may be no less prevalentce than depressive symptoms ( Chuong et al.,1994). Comorbidity of PMS/PMDD with anxiety disorder, phobia, obsessive-compulsive and panic disorders was demonstrated. In this study, we decided to assess psychiatric symptoms in PMS group compared to those without PMS.

4. Most women of reproductive age experience the premenstrual symptoms. Twenty to fifty percent have a broad variably defined premenstrual syndrome, but only 1.3% to 5.5% meet the diagnostic criteria for premenstrual dysphoric disorder established by the American Psychiatric Association in the DSM-IV.PMS occurs profoundly during the reproductive years (not before menarche, during pregnancy, or after menopause) and is improved by bilateral oophorectomy, treatment with the oral contraceptives containing drospirenone and ethinyl estradiol , or treatment with GnRH analogues that suppress ovulation(Eriksson,1999). Despite its frequency, the etiology and pathophysiology of PMS are quiet poorly understood. Key features of PMS include a lack of symptoms during the follicular phase, a peak of symptoms during the late luteal or premenstrual phase, and a sudden decrease of symptoms with the onset of menses ( Frackiewicz et al., 2001). It is much difficult to distinguish PMS from worsening of previously existing mood disorders in the luteal phase because of the overlap and similarity of symptoms in the luteal phase. Depression allied with PMS has been described typically as involving more anxiety, agitation, and mood lability than melancholic change. The most generally reported and bothersome mood symptom of PMS is irritability (Johnson et al., 1987).

5. In the search for causes of PMS, mean serum levels of ovarian steroids have been mainly seen to be within normal limits in women with PMS, but there seems to be greater in the levels of luteinizing hormone, estradiol , and 5-HIAA (a metabolite of serotonin) in these women. One theory is that PMS mainly shares vulnerability traits with mood or anxiety disorders, but the support for this idea is mainly from retrospective studies ( Ebner-Priemer et al., 2007). On the basis of these reports and the description and delineation of mood lability we hypothesized that there is a common proclivity to mood dysregulation between PMS and other mood disorders (Beck, 1996).

6. This specifically indicates a need to determine whether women complaining of PMS show evidence of mood instability in other phases of the menstrual cycle, excluding the premenstrual state (Sheehan et al., 1998). We hypothesized that a group of women with PMS but without any of the psychiatric disorder would show greater mood instability than a control group of women without PMS. To show a general tendency towards mood dysregulation , we anticipated that mood instability in the study group would be higher in other phases of the menstrual cycle, i.e., with the late luteal (premenstrual) condition excluded. Approval for the study was obtained from the University of Saskatchewan Behavioural Research Ethics Board. Participants gave much signed informed consent and were paid a small stipend after each month of the study ( Halbreich et al., 1985). PREMENSTRUAL SYNDROME OCCURENCE PMS can affect mainly menstruating women of any age, and the effect is different for each woman ( Faravelli et al.,1986). For some women, the symptoms can vanish as soon as menstruation starts. For others, it can be so adverse that it makes it hard to even get through the day. For these women, the PMS symptoms subside once the menstruation stops. Women stop experiencing PMS when they are pregnant or once they reach menopause phase. Women who have undergone hysterectomies can experience the PMS every month even if at least one functional ovary is left (Watson et al.,1988).

7. Journal of Midwifery, Women's Health and Nutrition, Mood Swings of Women: A Premenstrual Syndrome, S.Sreeremya,2019.vol(1)1:1-12.