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Premenstrual symptoms are very common. They vary from one cycle to the other and from one woman to another. They range from mild to severe. The list of premenstrual symptoms is quite long, but a few very common symptoms are worthy of note.

Weight gain, water retention, sleep disturbance, nipple discharge, muscle pain, joint pain, low sexual desire, acne, exacerbation of headaches and migraine are common physical features of premenstrual syndrome. Mood swings, an inability to concentrate and anxiety are common behavioral and psychological symptoms.

Some women experience menstrual irregularities, due to a whole host of causes. Apart from having irregular periods, some women experience delayed or missed periods despite having premenstrual symptoms.


The most common cause of missed periods despite having all the usual symptoms is pregnancy.

A simple urine hCG pregnancy test or an ultrasound scan of the pelvis will easily exclude a pregnancy. Not only normal intrauterine pregnancies, but also ectopic pregnancies stop menstruation. Ectopic pregnancies can present with severe lower abdominal pain and vaginal bleeding.

Anxiety and stress

Anxiety, stress and tension may delay or stop periods altogether. This is an example of cortical control of the menstrual cycle. The cerebral cortex exerts a significant degree of influence, especially on the timing of the menstrual cycle. Therefore relaxation techniques, meditation and other stress relief methods may indeed remedy the problem.


Contraceptive methods, especially hormonal methods, may cause irregular or missed periods. Depot injections, hormonal intrauterine devices and hormonal sub-dermal implants are particularly notorious for this. Oral contraceptive pills taken for either 21 or 28 days actually can be used to treat menstrual irregularities. It is better to consult a gynecologist before taking any medication.


Nutritional status has a key place in the hormonal control of menstruation. Severe obesity and low BMI both are directly related to irregular or absent periods.

Weight reduction is often the first step in treating menstrual disorders in obese women.

Maintaining a normal body mass index with a balanced diet and adequate exercise is essential.

Hormonal disorders

Endocrine disorders like hypothyroidism, diabetes and Cushing disease are related to irregular periods. Polycystic ovarian syndrome is a common ovarian disorder characterized by a lack of ovulation, formation of multiple ovarian cysts, subfertility, obesity, insulin resistance and irregular or absent menstruation.

A thorough medical checkup will uncover any co-morbidity and with proper treatment, associated premenstrual disorders will also go away.


Drugs like anti-hypertensive, oral hypoglycemic drugs, psychiatric drugs will cause menstrual irregularities. Decisions need to be taken either to stop the offending drug or to treat the adverse effect. Multidisciplinary care involving a gynecologist, pharmacologist as well as a psychiatrist is the way to go.

The premenopausal period may also be marked with the absence of bleeding despite having overwhelming premenstrual symptoms. Hot flushes, vaginal dryness and lack of libido may complicate matters.

High urine levels of FSH, LH, being in the correct age range, and having no mature follicles on an ultrasound scan puts menopause at the top of the list of possibilities. Hormonal replacement therapy relieves the symptoms.

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