Premenstrual syndrome (PMS) has a wide variety of signs and symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression. It's estimated that as many as 3 of every 4 menstruating women have experienced some form of premenstrual syndrome. Symptoms tend to recur in a predictable pattern. But the physical and emotional changes you experience with premenstrual syndrome may vary from just slightly noticeable all the way to intense. Still, you don't have to let these problems control your life. Treatments and lifestyle adjustments can help you reduce or manage the signs and symptoms of premenstrual syndrome. Symptoms The list of potential signs and symptoms for premenstrual syndrome is long, but most women only experience a few of these problems. Emotional and behavioral signs and symptoms Tension or anxiety Depressed mood Crying spells Mood swings and irritability or anger Appetite changes and food cravings Trouble falling asleep (insomnia) Social withdrawal Poor concentration Change in libido Physical signs and symptoms Joint or muscle pain Headache Fatigue Weight gain related to fluid retention Abdominal bloating Breast tenderness Acne flare-ups Constipation or diarrhea Alcohol intolerance For some, the physical pain and emotional stress are severe enough to affect their daily lives. Regardless of symptom severity, the signs and symptoms generally disappear within four days after the start of the menstrual period for most women. But a small number of women with premenstrual syndrome have disabling symptoms every month. This form of PMS is called premenstrual dysphoric disorder (PMDD). PMDD signs and symptoms include depression, mood swings, anger, anxiety, feeling overwhelmed, difficulty concentrating, irritability and tension. When to see a doctor If you haven't been able to manage your premenstrual syndrome with lifestyle changes and the symptoms of PMS are affecting your health and daily activities, see your doctor. Causes Exactly what causes premenstrual syndrome is unknown, but several factors may contribute to the condition: Cyclic changes in hormones. Signs and symptoms of premenstrual syndrome change with hormonal fluctuations and disappear with pregnancy and menopause. Chemical changes in the brain. Fluctuations of serotonin, a brain chemical (neurotransmitter) that's thought to play a crucial role in mood states, could trigger PMS symptoms. Insufficient amounts of serotonin may contribute to premenstrual depression, as well as to fatigue, food cravings and sleep problems. Depression. Some women with severe premenstrual syndrome have undiagnosed depression, though depression alone does not cause all of the symptoms
Diagnosis There are no unique physical findings or lab tests to positively diagnose premenstrual syndrome. Your doctor may attribute a particular symptom to PMS if it's part of your predictable premenstrual pattern. To help establish a premenstrual pattern, your doctor may have you record your signs and symptoms on a calendar or in a diary for at least two menstrual cycles. Note the day that you first notice PMS symptoms, as well as the day they disappear. Also be sure to mark the days your period starts and ends. Certain conditions may mimic PMS, including chronic fatigue syndrome, thyroid disorders and mood disorders, such as depression and anxiety. Your health care provider may order tests, such as a thyroid function test or mood screening tests to help provide a clear diagnosis. Treatment For many women, lifestyle changes can help relieve PMS symptoms. But depending on the severity of your symptoms, your doctor may prescribe one or more medications for premenstrual syndrome. The success of medications in relieving symptoms varies among women. Commonly prescribed medications for premenstrual syndrome include: Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) — which include fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and others — have been successful in reducing mood symptoms. SSRIs are the first line treatment for severe PMS or PMDD. These medications are generally taken daily. But for some women with PMS, use of antidepressants may be limited to the two weeks before menstruation begins. Nonsteroidal anti-inflammatory drugs (NSAIDs). Taken before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) can ease cramping and breast discomfort. Diuretics. When exercise and limiting salt intake aren't enough to reduce the weight gain, swelling and bloating of PMS, taking water pills (diuretics) can help your body shed excess fluid through your kidneys. Spironolactone (Aldactone) is a diuretic that can help ease some of the symptoms of PMS. Hormonal contraceptives. These prescription medications stop ovulation, which may bring relief from PMS symptoms. Lifestyle and home remedies You can sometimes manage or reduce the symptoms of premenstrual syndrome by making changes in the way you eat, exercise and approach daily life. Try these tips: Modify your diet Eat smaller, more-frequent meals to reduce bloating and the sensation of fullness. Limit salt and salty foods to reduce bloating and fluid retention. Choose foods high in complex carbohydrates, such as fruits, vegetables and whole grains. Choose foods rich in calcium. If you can't tolerate dairy products or aren't getting adequate calcium in your diet, a daily calcium supplement may help. Avoid caffeine and alcohol. Incorporate exercise into your regular routine Engage in at least 30 minutes of brisk walking, cycling, swimming or other aerobic activity most days of the week. Regular daily exercise can help improve your overall health and alleviate certain symptoms, such as fatigue and a depressed mood. Reduce stress Get plenty of sleep. Practice progressive muscle relaxation or deep-breathing exercises to help reduce headaches, anxiety or trouble sleeping (insomnia). Try yoga or massage to relax and relieve stress. Record your symptoms for a few months Keep a record to identify the triggers and timing of your symptoms. This will allow you to intervene with strategies that may help to lessen them. Alternative medicine Here's what's known about the effectiveness of complementary remedies used to soothe the symptoms of premenstrual syndrome: Vitamin supplements. Calcium, magnesium, vitamin E and vitamin B-6 have all been reported to soothe symptoms, but evidence is limited or lacking. Herbal remedies. Some women report relief of PMS symptoms with the use of herbs, such as ginkgo, ginger, chasteberry (Vitex agnus), evening primrose oil and St. John's wort. However, few scientific studies have found that any herbs are effective for relief of PMS symptoms. Herbal remedies also aren't regulated by the Food and Drug Administration, so there's no record of product safety or effectiveness. Talk with your doctor before taking any herbal products, as they may have side effects or interact with other medications you're taking. St. John's wort, for example, reduces the effectiveness of birth control pills. Acupuncture. A practitioner of acupuncture inserts sterilized stainless steel needles into the skin at specific points on the body. Some women experience symptom relief after acupuncture treatment.
Dr MOATAZ TAWFIK
GYNECOLOGIST AND OBSTETRICIAN
Overview Preterm labor occurs when regular contractions result in the opening of your cervix after week 20 and before week 37 of pregnancy. Preterm labor can result in premature birth. The earlier premature birth happens, the greater the health risks for your baby. Many premature babies (preemies) need special care in the neonatal intensive care unit. Preemies can also have long-term mental and physical disabilities. The specific cause of preterm labor often isn't clear. Certain risk factors might increase the chance of preterm labor, but preterm labor can also occur in pregnant women with no known risk factors. Symptoms Signs and symptoms of preterm labor include: Regular or frequent sensations of abdominal tightening (contractions) Constant low, dull backache A sensation of pelvic or lower abdominal pressure Mild abdominal cramps Vaginal spotting or light bleeding Preterm rupture of membranes — in a gush or a continuous trickle of fluid after the membrane around the baby breaks or tears A change in type of vaginal discharge — watery, mucus-like or bloody When to see a doctor If you experience these signs or symptoms or you're concerned about what you're feeling, contact your health care provider right away. Don't worry about mistaking false labor for the real thing. Everyone will be pleased if it's a false alarm. Risk factors Preterm labor can affect any pregnancy. Many factors have been associated with an increased risk of preterm labor, however, including: Previous preterm labor or premature birth, particularly in the most recent pregnancy or in more than one previous pregnancy Pregnancy with twins, triplets or other multiples Shortened cervix Problems with the uterus or placenta Smoking cigarettes or using illicit drugs Certain infections, particularly of the amniotic fluid and lower genital tract Some chronic conditions, such as high blood pressure, diabetes, autoimmune disease and depression Stressful life events, such as the death of a loved one Too much amniotic fluid (polyhydramnios) Vaginal bleeding during pregnancy Presence of a fetal birth defect An interval of less than 12 months — or of more than 59 months — between pregnancies Age of mother, both young and older Black, non-Hispanic race and ethnicity Complications Complications of preterm labor include delivering a preterm baby. This can pose a number of health concerns for your baby, such as low birth weight, breathing difficulties, underdeveloped organs and vision problems. Children who are born prematurely also have a higher risk of cerebral palsy, learning disabilities and behavioral problems. Prevention You might not be able to prevent preterm labor — but there's much you can do to promote a healthy, full-term pregnancy. For example: Seek regular prenatal care. Prenatal visits can help your health care provider monitor your health and your baby's health. Mention any signs or symptoms that concern you. If you have a history of preterm labor or develop signs or symptoms of preterm labor, you might need to see your health care provider more often during pregnancy. Eat a healthy diet. Healthy pregnancy outcomes are generally associated with good nutrition. In addition, some research suggests that a diet high in polyunsaturated fatty acids (PUFAs) is associated with a lower risk of premature birth. PUFAs are found in nuts, seeds, fish and seed oils. Avoid risky substances. If you smoke, quit. Ask your health care provider about a smoking cessation program. Illicit drugs are off-limits, too. Consider pregnancy spacing. Some research suggests a link between pregnancies spaced less than six months apart, or more than 59 months apart, and an increased risk of premature birth. Consider talking to your health care provider about pregnancy spacing. Be cautious when using assisted reproductive technology (ART). If you're planning to use ART to get pregnant, consider how many embryos will be transferred. Multiple pregnancies carry a higher risk of preterm labor. Manage chronic conditions. Certain conditions, such as diabetes, high blood pressure and obesity, increase the risk of preterm labor. Work with your health care provider to keep any chronic conditions under control. If your health care provider determines that you're at increased risk of preterm labor, he or she might recommend taking additional steps to reduce your risk.
Diagnosis Your health care provider will review your medical history and risk factors for preterm labor and evaluate your signs and symptoms. If you're experiencing regular uterine contractions and your cervix has begun to soften, thin and open (dilate) before 37 weeks of pregnancy, you'll likely be diagnosed with preterm labor. Tests and procedures to diagnose preterm labor include: Pelvic exam. Your health care provider might evaluate the firmness and tenderness of your uterus and the baby's size and position. If your water hasn't broken and there's no concern that the placenta is covering the cervix (placenta previa), he or she might also do a pelvic exam to determine whether your cervix has begun to open. Your health care provider might also check for uterine bleeding. Ultrasound. A transvaginal ultrasound might be used to measure the length of your cervix. An ultrasound might also be done to check for problems with the baby or placenta, confirm the baby's position, assess the volume of amniotic fluid, and estimate the baby's weight. Uterine monitoring. Your health care provider might use a uterine monitor to measure the duration and spacing of your contractions. Lab tests. Your health care provider might take a swab of your vaginal secretions to check for the presence of certain infections and fetal fibronectin — a substance that acts like a glue between the fetal sac and the lining of the uterus and is discharged during labor. These results will be reviewed in combination with other risk factors. You'll also provide a urine sample, which will be tested for the presence of certain bacteria. Treatment Medications Once you're in labor, there are no medications or surgical procedures to stop labor, other than temporarily. However, your doctor might recommend the following medications: Corticosteroids. Corticosteroids can help promote your baby's lung maturity. If you are between 23 and 34 weeks, your doctor will likely recommend corticosteroids if you are thought to be at increased risk of delivery in the next one to seven days. Your doctor may also recommend steroids if you are at risk of delivery between 34 weeks and 37 weeks. You might be given a repeat course of corticosteroids if you're less than 34 weeks pregnant, at risk of delivering within seven days, and you had a prior course of corticosteroids more than 14 days previously. Magnesium sulfate. Your doctor might offer magnesium sulfate if you have a high risk of delivering between weeks 24 and 32 of pregnancy. Some research has shown that it might reduce the risk of a specific type of damage to the brain (cerebral palsy) for babies born before 32 weeks of gestation. Tocolytics. Your health care provider might give you a medication called a tocolytic to temporarily slow your contractions. Tocolytics may be used for 48 hours to delay preterm labor to allow corticosteroids to provide the maximum benefit or, if necessary, for you to be transported to a hospital that can provide specialized care for your premature baby. Tocolytics don't address the underlying cause of preterm labor and overall have not been shown to improve babies' outcomes. Your health care provider won't recommend a tocolytic if you have certain conditions, such as pregnancy-induced high blood pressure (preeclampsia). If you're not hospitalized, you might need to schedule weekly or more-frequent visits with your health care provider so that he or she can monitor signs and symptoms of preterm labor. Surgical procedures If you are at risk of preterm labor because of a short cervix, your doctor may suggest a surgical procedure known as cervical cerclage. During this procedure, the cervix is stitched closed with strong sutures. Typically, the sutures are removed after 36 completed weeks of pregnancy. If necessary, the sutures can be removed earlier. Cervical cerclage might be recommended if you're less than 24 weeks pregnant, you have a history of early premature birth, and an ultrasound shows your cervix is opening or your cervical length is less than 25 millimeters. Preventive medication If you have a history of premature birth, your health care provider might suggest weekly shots of a form of the hormone progesterone called hydroxyprogesterone caproate, starting during your second trimester and continuing until week 37 of pregnancy. In addition, your health care provider might offer progesterone, which is inserted in the vagina, as a preventive measure against preterm birth. If you are diagnosed with a short cervix before week 24 of pregnancy, your health care provider might also recommend use of progesterone until week 37 of pregnancy. Recent research suggests that vaginal progesterone is as effective as cervical cerclage in preventing preterm birth for some women who are at risk. The medication has the advantage of not requiring surgery or anesthesia. Your doctor may offer you medication as an alternative to cervical cerclage. If you have a history of preterm labor or premature birth, you're at risk of a subsequent preterm labor. Work with your health care provider to manage any risk factors and respond to early warning signs and symptoms. Lifestyle and home remedies Preterm contractions might be Braxton Hicks contractions, which are common and don't necessarily mean that your cervix will begin to open. If you're having contractions that you think might be a symptom of preterm labor, try walking, resting or changing positions. This might stop false labor contractions. If you're in true preterm labor, however, your contractions will continue. Bed rest to manage preterm labor hasn't been shown to reduce the risk of preterm birth. Bed rest can lead to blood clots, emotional distress and muscle weakness. Coping and support If you're at risk of preterm labor or premature birth, you might feel scared or anxious about your pregnancy. This might be especially true if you have a history of preterm labor or premature birth. Consult your health care provider about healthy ways to relax and stay calm.
DR MOATAZ TAWFIK
GYNECOLOGIST AND OBSTETRICIAN
An ectopic pregnancy most often occurs in a fallopian tube, which carries eggs from the ovaries to the uterus. This type of ectopic pregnancy is called a tubal pregnancy. Sometimes, an ectopic pregnancy occurs in other areas of the body, such as the ovary, abdominal cavity or the lower part of the uterus (cervix), which connects to the vagina. An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue may cause life-threatening bleeding, if left untreated. Symptoms You may not notice any symptoms at first. However, some women who have an ectopic pregnancy have the usual early signs or symptoms of pregnancy — a missed period, breast tenderness and nausea. If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can't continue as normal. As the fertilized egg grows in the improper place, signs and symptoms become more noticeable. Early warning of ectopic pregnancy Often, the first warning signs of an ectopic pregnancy are light vaginal bleeding and pelvic pain. If blood leaks from the fallopian tube, you may feel shoulder pain or an urge to have a bowel movement. Your specific symptoms depend on where the blood collects and which nerves are irritated. Emergency symptoms If the fertilized egg continues to grow in the fallopian tube, it can cause the tube to rupture. Heavy bleeding inside the abdomen is likely. Symptoms of this life-threatening event include extreme lightheadedness, fainting and shock. Seek emergency medical help if you have any signs or symptoms of an ectopic pregnancy, including: Severe abdominal or pelvic pain accompanied by vaginal bleeding Extreme lightheadedness or fainting Shoulder pain Causes A tubal pregnancy — the most common type of ectopic pregnancy — happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role. Risk factors Previous ectopic pregnancy. If you've had this type of pregnancy before, you're more likely to have another. Inflammation or infection. Sexually transmitted infections, such as gonorrhea or chlamydia, can cause inflammation in the tubes and other nearby organs, and increase your risk of an ectopic pregnancy. Fertility treatments. Some research suggests that women who have in vitro fertilization (IVF) or similar treatments are more likely to have an ectopic pregnancy. Infertility itself may also raise your risk. Tubal surgery. Surgery to correct a closed or damaged fallopian tube can increase the risk of an ectopic pregnancy. Choice of birth control. The chance of getting pregnant while using an intrauterine device (IUD) is rare. However, if you do get pregnant with an IUD in place, it's more likely to be ectopic. Tubal ligation, a permanent method of birth control commonly known as "having your tubes tied," also raises your risk, if you become pregnant after this procedure. Smoking. Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. The more you smoke, the greater the risk. Complications An ectopic pregnancy can cause your fallopian tube to burst open. Without treatment, the ruptured tube can lead to life-threatening bleeding. Prevention There's no way to prevent an ectopic pregnancy, but here are some ways to decrease your risk: Limiting the number of sexual partners and using a condom during sex helps to prevent sexually transmitted infections and may reduce the risk of pelvic inflammatory disease. Don't smoke. If you do, quit before you try to get pregnant
Diagnosis A pelvic exam can help your doctor identify areas of pain, tenderness, or a mass in the fallopian tube or ovary. However, your doctor can't diagnose an ectopic pregnancy by examining you. You'll need blood tests and an ultrasound. Pregnancy test Your doctor will order the human chorionic gonadotropin (HCG) blood test to confirm that you're pregnant. Levels of this hormone increase during pregnancy. This blood test may be repeated every few days until ultrasound testing can confirm or rule out an ectopic pregnancy — usually about five to six weeks after conception. Ultrasound A transvaginal ultrasound allows your doctor to see the exact location of your pregnancy. For this test, a wandlike device is placed into your vagina. It uses sound waves to create images of your uterus, ovaries and fallopian tubes, and sends the pictures to a nearby monitor. Other blood tests A complete blood count will be done to check for anemia or other signs of blood loss. If you're diagnosed with an ectopic pregnancy, your doctor may also order tests to check your blood type in case you need a transfusion. Treatment A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed. Depending on your symptoms and when the ectopic pregnancy is discovered, this may be done using medication, laparoscopic surgery or abdominal surgery. Medication An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells. The medication is given by injection. It's very important that the diagnosis of ectopic pregnancy is certain before receiving this treatment. After the injection, your doctor will order another HCG test to determine how well treatment is working, and if you need more medication. Laparoscopic procedures Salpingostomy and salpingectomy are two laparoscopic surgeries used to treat some ectopic pregnancies. In these procedure, a small incision is made in the abdomen, near or in the navel. Next, your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the tubal area. In a salpingostomy, the ectopic pregnancy is removed and the tube left to heal on its own. In a salpingectomy, the ectopic pregnancy and the tube are both removed. Which procedure you have depends on the amount of bleeding and damage and whether the tube has ruptured. Also a factor is whether your other fallopian tube is normal or shows signs of prior damage. Emergency surgery If the ectopic pregnancy is causing heavy bleeding, you might need emergency surgery. This can be done laparoscopically or through an abdominal incision (laparotomy). In some cases, the fallopian tube can be saved. Typically, however, a ruptured tube must be removed. Coping and support Losing a pregnancy is devastating, even if you've only known about it for a short time. Recognize the loss, and give yourself time to grieve. Talk about your feelings and allow yourself to experience them fully. Rely on your partner, loved ones and friends for support. You might also seek the help of a support group, grief counselor or other mental health provider. Many women who have an ectopic pregnancy go on to have a future, healthy pregnancy. The female body normally has two fallopian tubes. If one is damaged or removed, an egg may join with a sperm in the other tube and then travel to the uterus. If both fallopian tubes have been injured or removed, in vitro fertilization (IVF) might still be an option. With this procedure, mature eggs are fertilized in a lab and then implanted into the uterus. If you've had an ectopic pregnancy, your risk of having another one is increased. If you wish to try to get pregnant again, it's very important to see your doctor regularly. Early blood tests are recommended for all women who've had an ectopic pregnancy. Blood tests and ultrasound testing can alert your doctor if another ectopic pregnancy is developing.
DR MOATAZ TAWFIK
GYNECOLOGIST AND OBSTETRICIAN