The Premenstrual Syndrome: Pathophysiology, Causes, Clinical Manifestation and Therapies

Running head: HEALTH
Student Name
Student No
Unit
Title: The Premenstrual Syndrome

HEALTH
Qn1. Pathophysiology of PMS
Premenstrual syndrome (PMS) is a condition characterized by behavioral, emotional
and physical symptoms which tend to be more severe and acute during the luteal phase of the
menstrual cycle and definitely end after menstruation (Walsh, Ismaili, Naheed, and O’Brien,
2015). Mostly affects women of the reproductive age and causes physical discomfort in some
weeks to menstruation. The symptoms could be mild but in other cases they are severe to
affect ones daily activities (Yonkers et al. 2008). According to O’Brien, Rapkin, Dennerstein,
and Nevatte (2011), its symptoms do not exceed 14 days before menses and has irritability
and anger as the long lasting and most severe symptoms. According to Mayo clinic (2018),
the behavioral and emotional sign and symptoms due to this syndrome include: depressed
mood, tension, anxiety, crying spells, mood swings, anger, change in appetite, irritability,
food cravings, insomnia, poor concentration, social withdrawal and change in libido.
The physical signs and symptoms are headache, fatigue, joint and muscle pains,
constipation, diarrhea, acne flare ups, weight gain, breast tenderness and alcohol intolerance.
Tracey experienced almost all these signs and symptoms. Earlier research linked this
syndrome with abnormal ovarian sex steroid levels but this has been dropped due to lack of
difference between asymptomatic and symptomatic women and also lack of enough study to
show the difference in progesterone levels. Research shows that almost 8 percent of
menstruating ladies are suffering from this syndrome. The International Society for
Premenstrual Disorder deviced a method for premenstrual disorder (PMD). They also divided
premenstrual syndrome into core and variant. Core PMD has spontaneous ovulatory
menstrual cycles and could be subdivided into predominantly physical, psychological or
mixed symptoms (Kedian & O’Brien, 2012). Variant PMD is subdivided into premenstrual
exacerbation, PMS with lack of menstruation, PMS with anovulatory ovarian activity and
progesterone induced PMS (Rapkin & Kou, 2008).

HEALTH
Qn2. Causes of PMS
According to Moreno and Zuckerman (2016), the real causes of premenstrual
syndrome are unknown but several factors are thought to cause this condition. The signs and
symptoms of this syndrome change with hormonal change and cease with start of menopause
and pregnancy. It is therefore thought to be as a result of the cyclic change in hormones. It is
also thought to be caused by chemical changes in the brain and depression (Mayo clinic,
2018).
Earlier research linked this syndrome with abnormal ovarian sex steroid levels but this
has been dropped due to lack of difference between asymptomatic and symptomatic women
and also lack of enough study to show the difference in progesterone levels. Sex steroids
easily find their way past blood brain barriers, whose receptors are high in concentration in
the brain, including in the hypothalamus and amygdala. It is believed that progesterone is
metabolized in the brain to allopregnanolone and pregnanolone. These stimulate the gama-
aminobutryic acid (GABA) inhibitory neurotransmitter system. The GABA receptors are
responsible for the cognition and mood alteration (Rapkin & Akopians, 2012). Low
concentration of allopregnanolone causes aggression, anxiety and negative moods, like anger,
irritability and tiredness just as Tracey experienced. The GABA receptors sensitivity to
allopregnanolone decreases on high concentration which results to the worsening of the PMS
symptoms during luteal phase. Tracey’s case aggravated just before menstruation began.
Qn3. Difference between clinical manifestation of polycystic ovary syndrome and
PMS
According to Ramanand, Ghongane, Ramanand, Patwardhan, Ghanghas & Jain,
(2013), the diagnosis criteria for polycystic ovary syndrome (PCOS) were obesity, polycystic
ovary, oligomenorrhea and hirsutism. This disorder is now thought to be a heterogeneous