Understanding Premenstrual Syndrome: Causes, Symptoms, and Treatment

This article discusses the pathophysiology of Premenstrual Syndrome (PMS) and relates Tracey's symptoms to its pathophysiology. It also covers the common causes of PMS, the difference between clinical manifestations of Polycystic Ovary Syndrome and PMS, and the most common therapies for PMS. Additionally, it discusses lifestyle changes that can help with PMS syndrome.

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Reproductive system
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Case Assignment 2
Topic1: Reproductive System
The following is a case study with four questions.You are required to respond to FOUR
questions. Response to each question should not exceed 250 words, and the length of the
entire assignment is 1000 words.
Tracey Wilson’s Premenstrual Syndrome (PMS) Case Study
Tracey is a 38-year-old married woman, a mother of three healthy kids; two daughters,
ages 10 and 12 and a four-year-old son. Tracey is a successful businesswoman, often
smokes and only consumes alcohol in moderation at social events.
She runs Pizza hut at Belmont Village Shopping Centre. Tracey presented to Belmont
Private Hospital, Belmont, complaining of a 4-month history of symptoms that include
anger, irritability, breast tenderness, tiredness, nausea, acne and abdominal blotting. She
also confirmed that she had food cravings for salty snacks lately.
These symptoms have been HIGHLY repetitive and predictable for the last three
menstrual periods, usually, occur three days or one week before menses. Her menstrual
cycle has been remarkably predictable for the last two years. However, her symptoms
aggravated just before menstruation.
She had severe urinary tract infections 13 years ago, and her ovarian cyst was removed
eight years ago. She was referred to the Family Planning Clinic based in Brisbane by her

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obstetrician and gynaecologist Dr Sarah Johnson.
Questions
1. Explain the pathophysiology of Premenstrual Syndrome and relate Tracey’s
symptoms to its pathophysiology?
The pathophysiology of Premenstrual Syndrome is quite controversial with
different theories .According to one of the theories, the pathophysiology of PMS
is centered on the ovarian cycle. The sex steroids usually pass very easily the
blood brain barrier and the receptors are many in the region of the brain such as
amygdala and the hypothalamus. Metabolism of the hormone progesterone
produces allopregnalone and pregananolone. This two are the ones that stimulate
the gamma-aminobutyric acid inhibitory neurotransmitter system.
It is the GABA receptors that alters the mood, cognition and affect the patient as
Tracey was feeling (Bauman, 2015). When the level of pregnanolone and the
allopregnanolone result to anxiolytic, sedative as well as anesthetic effects. When
they are low, they result to anxiety, negative mood and finally aggression which
was the case of Tracey (Yonkers, Cameron, Gueorguieva, Altemus, & Kornstein,
2017). The symptoms worsen during the luteal phase due to the continuous
exposure of the GABA receptors to high concentrations of allopregnanolone.
(Purdue-Smithe, Manson, Hankinson, & Bertone-Johnson, 2016). The latter
increase monoamine oxidase that reduce the presence of 5-hydroxyptamine and
this also leads to depressed moods (Bertone-Johnson, Whitcomb, Rich-Edwards,

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Hankinson, & Manson, 2015). Estrogen on the other hand increase the breakdown
of monoamine oxidase and this increase the presence of tryptophan in the brain
and this stimulates serotonin transport that stimulate 5-HT binding sites in the
brain and this leads to antidepressant effect which was the case with Tracey .It is
therefore ideal to conclude that PMS is as a result of fluctuations in sex hormones
that affect serotonin.
2. Discuss the common causes of Premenstrual Syndrome.
Premenstrual syndrome is caused by three main factors that include the cyclic
changes in hormones, chemical changes in the brain and finally depression
(Rahmanian, 2017). According to different studies,hormonal fluctuations such as
estrogen are the ones that results to the PMS.PMS is also as a result of
fluctuations in different chemicals that are found in the brain such as the serotonin
and this is the chemical substance that alters mood states and triggers the PMS
symptoms (Ryu & Kim, 2015). Low levels of serotonin on the other hand may
lead to premenstrual depression, fatigue, food cravings and sleep problems.
Depression also cause PMS though not to a big extent.
There is another theory that attempts to explain the causes of PMS and it links the
condition to the luteal phase. According to this theory, the progesterone increase
in the body of women if the fused ova and sperms get implanted in the uterus.
Estrogen on the other hand reduce. This condition is therefore believed to arise
when there is an interaction of sex hormones and the brain. This involves the sex
hormones and the neurotransmitter known as serotonin. The neurotransmitter

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serotonin is the one that controls several functions in the brain such as moods and
sensitivity to pain. Therefore, the fluctuating levels of serotonin brought about by
the interaction with sex hormones is the one that reduce levels of serotonin and
eventually brings about PMS. This is the reason why during treatment of the
condition, the woman would be injected with drugs such as fluoxetine that
increases the levels of serotonin.
3. Describe the difference between clinical manifestations of Polycystic Ovary
Syndrome and Premenstrual Syndrome.
Polycystic ovarian syndrome is a condition in which there is an imbalance in
hormones during the reproductive age of women. Women who experience this
condition experience infrequent or elongated menstrual periods. They might also
have excess male hormones such as androgens. The ovaries also develop small
collections of fluids referred to as follicles and this makes them fail to release the
egg on a regular basis.
The clinical manifestation of PMS include abdominal
bloating,headaches,depression,sadness,anxiety,fatigue,constipation,food cravings,
diarrhea, acne and sore breaths (Liao et al., 2017). The clinical manifestations of
polycystic ovarian syndrome include irregular periods, heavy bleeding, hair
growth, acne, weight gain, darkening of the skin and headaches. Women with
PCOS might experience less than 9 periods in a single year. They might also
experience more than thirty five days between the periods and the abnormally
high or heavy periods. The clinical manifestation of the Polycystic Ovary

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syndrome are due to the presence of excess male hormone called androgens that
make the ovary to develop follicles and this makes it difficult for the ovaries to
release the eggs (Kaewrudee, Kietpeerakool, Pattanittum, & Lumbiganon, 2018).
The clinical manifestations of the PMS on the other hand is due to the
exaggerated response to hormones such as serotonin. In conclusion ,the difference
between the clinical manifestations of the polycystic ovarian syndrome and the
premenstrual syndrome is due to the fact In PCOS ,there are high level of the
male hormone androgen while in PMS ,there is fluctuations in the sex hormones
that affect the neurotransmitter serotonin.
4. Outline the most common therapies for Premenstrual Syndrome and discuss the
lifestyle changes to help with PMS syndrome.
There are different treatment options for PMS. The first therapy is the use of
Antidepressants that include selective serotonin reuptake inhibitors (SSRIs) such
as fluoxetine, paroxetine and others have been used to reduce the symptoms of
PMS especially moods. These are the first line drugs for the treatment of PMS.
These drugs are taken on a daily basis but in some women it can be limited to 2
weeks before menstruation. Another drug is the Nonsteroidal anti-inflammatory
drugs (NSAIDs) and they are used prior to the onset of menstruation (Yonkers,
2009). The common NSAIDs include ibuprofen and naproxen sodium that usually
ease cramping as well as breast discomforts. Diuretics are also important since
they assist the body reduce the body fluids to reduce swelling and bloating. There
are also the hormonal therapy where certain hormones are introduced to stop

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ovulation that relieves the PMS symptoms. Studies have also shown that
Benzodiazepines can reduce depression among patients suffering from PMS.
Lifestyle changes have also been used to treat or improve the symptoms of the
PMS. This include modifying the diet by eating food with less salts, rich in
calcium and the patient should avoid caffeine as well as alcohol. Exercise is also
important such as swimming and this can be used to reduce fatigue and
depression. The patient should also reduce stress by sleeping and massage to relax
.There are natural medicines that have been used to treat this condition as well.
Studies have found out that the fruit of the chaste berry can treat PMS.
References

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Bauman, D. (2015). Premenarcheal “Premenstrual” Dysphoric Disorder, Is There
Such an Entity? A Case Report and Review of the Literature. Journal of
Pediatric and Adolescent Gynecology, 28(2), e51-e52.
doi:10.1016/j.jpag.2015.02.048
Bertone-Johnson, E. R., Whitcomb, B. W., Rich-Edwards, J. W., Hankinson, S. E., &
Manson, J. E. (2015). Premenstrual Syndrome and Subsequent Risk of
Hypertension in a Prospective Study. American Journal of Epidemiology,
kwv159. doi:10.1093/aje/kwv159
Kaewrudee, S., Kietpeerakool, C., Pattanittum, P., & Lumbiganon, P. (2018).
Vitamin or mineral supplements for premenstrual syndrome. Cochrane
Database of Systematic Reviews. doi:10.1002/14651858.cd012933
Liao, H., Pang, Y., Liu, P., Liu, H., Duan, G., Liu, Y., … Deng, D. (2017). Abnormal
Spontaneous Brain Activity in Women with Premenstrual Syndrome Revealed
by Regional Homogeneity. Frontiers in Human Neuroscience, 11.
doi:10.3389/fnhum.2017.00062
Purdue-Smithe, A. C., Manson, J. E., Hankinson, S. E., & Bertone-Johnson, E. R.
(2016). A prospective study of caffeine and coffee intake and premenstrual
syndrome. The American Journal of Clinical Nutrition, 104(2), 499-507.
doi:10.3945/ajcn.115.127027
Rahmanian, V., Zolala, F., Mohseni, M., Baneshi, M., & KHalili, N. (2017).
Relationship between Body Image and Social Participation in Pregnant
Women of Jahrom City, Iran. Quarterly of Horizon of Medical Sciences,
23(2), 111-116. doi:10.18869/acadpub.hms.23.2.111

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Ryu, A., & Kim, T. (2015). Premenstrual syndrome: A mini review. Maturitas, 82(4),
436-440. doi:10.1016/j.maturitas.2015.08.010
Yonkers, K. A. (2009). Antidepressant Treatment for Premenstrual Syndrome
and Premenstrual Dysphoric Disorder. PsycEXTRA Dataset.
doi:10.1037/e651992010-001
Yonkers, K. A., Cameron, B., Gueorguieva, R., Altemus, M., & Kornstein, S. G.
(2017). The Influence of Cyclic Hormonal Contraception on Expression of
Premenstrual Syndrome. Journal of Women's Health, 26(4), 321-328.
doi:10.1089/jwh.2016.5941