Premenstrual Syndrome

  • Basics

    Premenstrual syndrome (PMS) encompasses a wide range of physical, emotional, and behavioral problems that occur cyclically in association with menstrual periods.

    Most people use the term premenstrual syndrome (PMS) somewhat loosely to describe a wide variety of mild and moderate symptoms. PMS occurs during the second half of the menstrual cycle (the premenstrual period) when certain hormonal changes occur. Symptoms typically involve physical discomfort such as breast tenderness and swelling, weight gain, and pelvic pain. Food cravings and mood changes such as irritability, anxiety, or depression are also common with PMS. Symptoms usually develop after midcycle ovulation and resolve within a day or two of the onset of menstrual bleeding.

    Most women are affected by PMS at some point during their reproductive years. Approximately 20% to 40% of women experience mild symptoms, while 2% to 10% experience symptoms that are severe enough to interfere with their work, social activities, or relationships. There are a variety of treatment options for the relief of PMS symptoms, including exercise, stress reduction, dietary changes, and medications.

    A related premenstrual disorder, called premenstrual dysphoria disorder (PMDD), has more distinct and severe signs and symptoms than PMS. Marked emotional disturbances that are severe enough to interfere with usual activities must be present for a diagnosis of PMDD. These emotional disturbances may include moodiness, anger or irritability, anxiety, and depression.

  • Causes

    PMS is likely caused by many factors.

    Because numerous symptoms have been attributed to PMS, clinicians consider it likely that the syndrome has several causes. Monthly hormonal changes certainly play a part; however, no hormonal abnormalities have been identified in individuals who suffer from PMS. In fact, no differences in hormone levels have been detected between women who suffer from PMS and women who don't. It appears instead that women with PMS have an abnormal response to the normal hormonal changes that occur each month.

    Some studies suggest that calcium levels, in addition to the fluctuating hormone levels in the premenstrual phase of a woman's cycle, may interfere with serotonin in the brain. Serotonin is a chemical that, when not utilized properly by nerves in the brain, may affect mood, anxiety, and sleep. Some success has been reported in using antidepressants known as selective serotonin-reuptake inhibitors (SSRIs) to ease PMS symptoms. When SSRIs are used to treat depression, the medication must be taken every day, and it may take several weeks before symptoms improve. When SSRIs are used to treat PMS, the medication may only need to be taken during the premenstrual phase of a woman's cycle, and can begin to ease symptoms within 1 or 2 days of treatment.

    Researchers have also noticed familial patterns of PMS, which suggests a genetic (inherited) predisposition to PMS in some cases.

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