Premenstrual syndrome is a combination of psychological and physical symptoms that begin during the luteal phase of menstrual life. This presentation consists of concise content for PMS required for final year BPT students. I hope this helps you to clear your concepts for the same. Thank you for your time.

1. Pre-Menstrual Syndrome
Made by & Presented By: Rutvi Raualji (PT)
(MPT- Women’s Health)
Presented to: Final Yr. BPT

2. Contents
• Introduction
• Aetiology
• Diagnostic Criteria
• Clinical features
• Differential Diagnosis
• References

3. Introduction
• Pre-Menstrual Syndrome (PMS) is a combination
of psychological and physical symptoms that
begin during the luteal phase of menstrual cycle
(up to 14 days prior to menses).
• It is characterized by symptoms which usually
cease by the end of menstruation, with a
symptom-free period till ovulation.
• Severity ranges form mild to severe- may hinder
their work and ADL activities.
• The most severe form of PMS is defined as
PREMENSTRUAL DYSPHORIC DISORDER
(PMDD).
• Prevalence in India is 43%; in adolescence: 49.6%;
severe PMS: 3% to 8% women.

4. Aetiology
1. After ovulation, oestrogen and progesterone levels
begin falling dramatically if not pregnant- goes
away within a few days after a woman’s period starts
as hormone levels begin rising again.
2. According to molecular biology studies, the
decreased oestrogen causes the hypothalamus to
reduce norepinephrine, which triggers a decline
in acetylcholine, dopamine, and serotonin that
leads to insomnia, fatigue, depression.
3. Dietary factors such as consumption of fast food,
drinks containing sugar, deep-fried foods, and
lifestyle factors such as less habitual exercise and
poor sleep quality is significantly associated with
PMS.

5. Diagnostic Criteria- American College of
Obstetricians and Gynaecologist (ACOG)
• Symptoms must:
1. Be present in the 5 days before a period
for at least 3 menstrual cycles in a row.
2. End within 4 days after period starts.
3. Interfere with some normal activities.

6. Clinical Presentation
Physical
1. Abdominal bloating or cramping
2. Fatigue
3. Constipation
4. Headache
5. Breast tenderness
6. Change in appetite (food
cravings)
7. Disturbance in sleep
8. Skin problems, acne
9. Muscles and joint pain
10. Swelling of hands and feet
Emotional
1. Depression
2. Anxiety
3. Crying spells
4. Less interest in intercourse
5. Insomnia
6. Poor concentration
7. Anger outburst
8. Irritability
9. Confusion
10. Social withdrawal
11. Increased nap taking

7. Differential Diagnosis
1. Depression
2. Anxiety
3. Perimenopause
4. Chronic fatigue syndrome
5. Thyroid disease

8. Management
• Aim: To reduce the effect of symptom on daily routine activities.
• Techniques:
1. Medical management
2. Aerobic and resisted exercises
3. Yoga
4. Lifestyle modifications
5. Cognitive Behavioural therapy

9. 1.) Medical management
1. Selective serotonin uptake
inhibitors (for moderate to severe
PMS)
2. Oral contraceptive pills
3. Antidepressants
4. NSAIDS like Ibuprofen- to reduce
pain
5. Diuretics- to reduce water retention

10. 2.) Lifestyle modifications
➢Supplementations: of calcium, magnesium, and vitamin
E
➢Dietary advices:
1. Eat diet rich in complex carbohydrates- reduce mood
symptoms and food cravings (example- whole-wheat
bread, pasta, cereals, barley, brown rice, beans, and
lentils)
2. Calcium rich diet- like yogurt and leafy green
vegetables.
3. Decrease intake of fat, sugar, and salt
4. Avoid caffeine and alcohol
➢Eating schedule- 6 meals/day rather than 3 large meals.
Keep blood sugar level stable.

11. 3.) Physiotherapy
Management
1. Aerobics and resisted exercise play
major role to reduce pain and
discomfort.
2. Modalities: TENS, Hot pack,
Acupuncture, Acupressure.
3. Abdominal stretches can also help in
reducing the symptoms.

12. 4.) Yoga
• Why? Yoga reduces the stress induced negative effects to immune system by
regulating positively the adjustment immunoglobulin A and reduces harmful
inflammatory secretions.
1. Kapalbharti pranayama,
2. Cat-cow pose,
3. Child’s pose,
4. Plank pose,
5. Cobra pose,
6. Savasana for relaxation

13. 5.) Cognitive behavioural therapy
• CBT is a method that can help manage problems by changing the way patients
would think and behave. It is not designed to remove any problems but help
manage them in a positive manner.
• Negative thoughts (example: Back pain) -> Negative feelings (depression and
anxiety) and maladaptive health behaviours (skipping treatment sessions) ->
reinforces negative cycle.
• Via education, such negative thought can be changed or better understood, then it
can break down this negative cycle.

14. References
1. Vaghela N, Mishra D, Sheth M, Dani VB. To compare the effects of aerobic
exercise and yoga on Premenstrual syndrome. Journal of education and health
promotion. 2019;8.
2. Rohmah, Yuni Khoiriyatul Mujtahidah and Mukhoirotin Mukhoirotin???.
“Abdominal stretching to reduce premenstrual syndrome: a case series.” (2020).

15. Thank You..