Brief Answer:
Premenstrual syndrome may be the cause- detailed explanations below

Detailed Answer:
Hello,

The symptoms you describe especially if they are specifically related to the menstrual cycle can be caused by what is called the premenstrual syndrome.

Different patients experience different symptoms among the wide spectrum of symptoms it may cause and also in different severity but in all cases, there is a clear relation with the menstrual cycle. This is due to hormonal changes that happen during this phase of the menstrual cycle and way the body reacts to it.

Normally blood tests and examinations come all normal. If the TSH is suppressed it might cause some of the symptoms but would not have it related to menstruation. Still, it might be good to monitor the TSH in time and if it continues to get more suppressed you might need to rule out Graves disease with TSH, FT4, antibodies for Graves, iodine uptake test of the thyroid gland, etc.

To diagnose the premenstrual syndrome you need to keep a calendar of the symptoms and menstruation for a few months and this will help the doctor clearly localize symptoms related to menstruation. If there is such a clear relationship and all the other tests come out normal then very likely this is a premenstrual syndrome.

To treat it generally different medications are tried among which are:

- SSRI group of medications used for depression treatment are found to help relieve symptoms of premenstrual syndrome in some patients

- NSAIDs like ibuprofen or meloxicam are used in combination with other drugs to relieve symptoms

- Oral contraceptives inhibit ovulation and may help with the premenstrual syndrome in some patients

- Some patients benefit from multivitamin supplements or herbal remedies (no clear proven scientific data for these are available though)

- A healthy lifestyle with avoiding smoking, alcohol and energy drinks but adding regular exercise and relaxation techniques may help improve the quality of life in patients with premenstrual syndrome.

To conclude I would recommend you to see a Gynaecologist as the premenstrual syndrome is mostly treated by Gynaecologists and discuss the chance of having the premenstrual syndrome and how to further proceed. Maybe a good gynaecological exam is needed, with pap smear if not done in the last 2-3 years, as a routine examination might be indicated as well.

Hope I have answered your query. Let me know if I can assist you further.

Take care
Regards,
Dr Antoneta Zotaj
General & Family Physician

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