ABSTRACT

Premenstrual syndrome (PMS) is a health problem that occurs with physical and psychological symptoms presenting about five days before menstruation, end within a few days after the onset of menstruation. The most common symptoms are appetite changes, edema, breast tenderness, abdominal pain, back pain, headache, fatigue, insomnia, depressive affect, irritability, angry outbursts andanxiety. Most women’s half of lifes go through with premenstrual problems and quality of life is affected negatively. PMS prevalence is notably high in the world and in our country. In this respect, it is important to increase awareness of health professionals and women about PMS. The aim of this review is to explain current approaches of PMS management in the context of international guidelines. Getting detailed anamnesis for the diagnosis of PMS, if necessary, consultations and laboratory investigations are carried out. In addition, the diagnosis of PMS is confirmed by assessing women’s symptom records for at least two months showing the type of symptoms and the time of appearance of these symptoms in the menstrual cycle. PMS management is carried out gradually by multidisciplinary team that adopted an integrative holistic approach in the direction of individualized plan. The first step includes creating awareness about PMS, teaching to women self-screening, lifestyle changes, regulation of diet, methods of coping with stress. In the second step, cognitive behavioral therapy and complementary alternative therapies are implemented. If the problem continues, there is pharmacological treatment in the third step. Finally, surgical treatment is applied in the fourth step.

Introduction

Repeated menstruation every month in women’s life is considered to be a sign of being healthy. However, the symptoms that occur in the second half of the menstrual cycle negatively affect the life of most women (1). The American College of Obstetricians and Gynecologists defines the period which occurs approximately five days before menstruation and ends in a few days after menstruation starts and is accompanied by physical and psychological symptoms as premenstrual syndrome (PMS) (2). The late twenties and mid-fifties are the periods when PMS is seen commonly (3). In the premenstrual period, changes in appetite such as excessive eating and craving, weight gain, edema, breast tenderness, and swelling and pain in the joints, abdominal pain, stomach problems, back pain, headaches, vertigo and dizziness, sweating in hands and feet, fatigue, skin problems such as acne, insomnia and short-term drowsiness, decreased libido, depressive mood, anger outbursts, irritability, crying spells, anxiety, restlessness, and confusion have been observed (2,3). Because of the problems associated with PMS, women experience change in body perception, decrease in self-confidence, social isolation and interpersonal relationships are disrupted (4,5). It is also stated that PMS leads to drug addiction, increased tendency to have an accident and to commit crime, economic losses, and decline in academic achievement (4,6).

The prevalence of PMS was examined, Royal College of Obstetricians and Gynaecologists reported that 4 out of 10 women have premenstrual symptoms and 5-8% of them is severely affected by PMS (4). In addition, PMS is seen in France at the lowest rate (12%) and Iran at the highest rate (98%) (7). PMS is also very common in our country and especially women in young age group are reported to have a high rate (66%-91.8%) of PMS in studies (8-10). Although the prevalence of PMS is influenced by cultural characteristics, PMS is a common female health problem. Given the fact that half of women’s lives have passed through premenstrual period problems, it is important to raise awareness of health workers and to teach women the necessary self-care practices for PMS management. This review aims to present current approaches to PMS management accompanied by international guidelines.

Conclusion

PMS is a common health problem, and women spend half their life with premenstrual problems and experience a reduction in self-confidence, social isolation, decline in academic achievement, increase in accident tendency and loss of Labor. With the management of PMS, the quality of life can be improved. The first step in PMS management is to create awareness, to make women self-screen, adopt lifestyle changes, apply nutrition suggestions and use stress coping methods. If these methods are insufficient, CBT and CAT in the second step are applied. If PMS continues to affect daily life negatively; hormonal, non-hormonal and symptomatic treatment in the third step; oophorectomy or laparoscopic hysterectomy + bilateral salpingo-oopherectomy in the fourth step are applied. In this context, it is important for women suffering from PMS to be monitored by health workers and it is recommended to establish our national PMS management guide and to develop models in PMS management and to increase evidence-based research. At the same time, it is recommended that women who are admitted to primary health care institutions should be evaluated routinely in terms of PMS. Also it is recommended to give awareness training for young people in high schools and universities, to set up counseling units, and to organize social awareness campaigns using the press organs.