Dear Doctor,

I am 33 and have terrible mood swings and feel really depressed for a week before my period, my mood completely changes during this period. Is there anything I can do about PMS? Emily

Dear Emily,

PMS or premenstrual syndrome is the term used for symptoms that a woman experiences just before menses. The range of physical symptoms and signs is very wide.

Just before menses a woman can have anxiety, depression, food cravings, feeling of fatigue, insomnia, lack of interest in sex, social withdrawal, one or more of these complaints.  It may be associated with sense of heaviness over breasts, swelling over feet, pain on touching the breasts, abdominal bloating, constipation or diarrhea, flare up of acne, e.t.c.  one or more signs as well.

In some women, these symptoms and signs may be mild, whereas in some it may be severe, affecting their quality of life.  In majority of women, these occur in a predictable manner, appearing 3 to 7 days before menses in the same intensity and having disappeared after start of bleeding.  But in few women, the symptoms become more and more troublesome with passing of time. After menopause, one gets rid of these problems.

What exactly causes PMS is not known. There are different speculations to it. One theory is that, changes in the hormone levels, just before menses, affects the neurochemicals in the brain, causing mood swings. Rise of progesterone levels causes swollen feet and heaviness over breasts. Some women may be suffering from pre-existing depression, which is aggravated during this period. There may be an underlying thyroid disorder in some women, which may have symptoms overlapping with PMS or may be the problem underlying the symptoms.

Majority of women suffering from PMS benefit from life style modifications alone. Restricting salt intake and fat intake, taking fresh green vegetables, fruits, whole grains and healthy milk products is useful. Drinking lots of water is also useful.  It is also good to take adequate rest. Regular physical exercise energises and refreshes the body, hence should be done. Only caution needed is exercise should not be done till point of exhaustion.

If the depression and or anxiety is troublesome, anxiolytic and anti-depressant drugs can help. One needs to consult a doctor if there is severe bloating, pain in lower abdomen or persistent swelling over feet. This is important to exclude any underlying medical problem.

     Dr. Rachna   Pande is a

specialist in internal medicine.