What are the causes of PMS?

• The exact cause of PMS is not known. It could be linked to changes in the levels of your hormones (decrease in estrogen level and increase in progesterone level) and body chemicals.

• In PMS, there is a decrease in the secretion of melatonin (the hormone that helps you fall asleep) which could explain the difficulty of falling asleep as well.

What happens when oestrogen levels drop:

• When oestrogen levels drop, a hormone called serotonin drops as well. Also called the happy hormone, serotonin normally makes us feel good and positively influences our mood.

• Low serotonin levels are thought to contribute to premenstrual depression, as well as fatigue, impulsive behaviour, irritability, crying spells and intense craving for food, especially carbohydrates.

What happens when progesterone levels increase:

• Progesterone levels are high during PMS, which alters GABA functioning. This may result in difficulty in concentration. Progesterone is the main hormone that causes water retention. This is why physical symptoms like weight gain and swelling (abdomen, feet, and ankle), bloating, breast tenderness are most prevalent in PMS.

• Higher progesterone levels also increase the production of an oily substance (‘sebum’) from glands called sebaceous glands in our skin, as well as close the pores. This excess production of sebum along with closed pores causes the sebum to build up in the skin and get stuck beneath the skins surface resulting in acne.

When should I consult my doctor for PMS at Saavi Women's Hospital, Ahmedabad?

• If you are getting symptoms, you should write them down in a diary for at least two menstrual cycles in a row. Your doctor will then review your diary with you to see whether your symptoms fit the pattern of PMS.

What are the treatment options at Saavi Women's Hospital, Ahmedabad for PMS?

Dr. Namrata Shah & Dr. Namrata Shah & Dr. Dhaval Shah after carefull history taking and examination, can be certain of a diagnosis of PMS and guide you through one of the treatment options suitable for your sfecific symptoms.

A. Lifestyle changes

• In the first instance, you can take some positive steps to try to improve your symptoms by:
  • Doing more exercise
  • Eating a healthy balanced diet
  • Trying to reduce and manage stress, for example by using meditation, yoga and mindfulness.

B. Complementary therapy

• Supplements of calcium, vitamin D may be helpful.
• Evening primrose oil can reduce breast tenderness.

C. Medical treatment

**A) Non-hormonal**
Anti spasmotic may be prescribed for symptomatic relief for the patient.

**B) Hormonal**

**Combined oral contraceptive pill**
* Some women find using the combined oral contraceptive pill helps with PMS symptoms.
* Newer types of contraceptive pills containing a progestogen called drospirenone have been shown to improve PMS symptoms.
* These are considered as first-choice treatments.

D. Surgical treatment

• Your doctor will only suggest surgical treatment if you have severe symptoms and all other treatments have not helped.
• Removal of your uterus along with both ovaries and fallopian tubes can help to improve severe PMS symptoms by making you menopausal.
• Surgical treatment such as endometrial ablation or hysterectomy without removal of both ovaries is not recommended for treatment of PMS.

Cost of management of PMS at Saavi Women's Hospital, Ahmedabad

The cost of management of PMS in Ahmedabad depends on the specific cause and its treatment. Dr. Namrata Shah & Dr. Namrata Shah & Dr. Dhaval Shah will discuss the cost and payment options with you during your consultation.