PMS

Women may experience emotional and physical changes prior to menstruation. The medical term for these changes is "premenstrual syndrome," commonly called PMS. More than 150 symptoms are associated with PMS, ranging from breast tenderness to nausea to anger and irritability.

Premenstrual emotional and physical changes occur in nearly 80% of menstruating women. The symptoms vary from woman to woman and from cycle to cycle. Their intensity ranges from mild to incapacitating. About 20% to 40% of women who have PMS experience symptoms that make life difficult and 2.5% to 5% experience PMS that is debilitating.

It is not clear what causes premenstrual syndrome. A combination of physiological, genetic, nutritional, and behavioral factors are likely involved. There is no diagnostic test for PMS. Tests may be used rule out other conditions in women who experience severe symptoms. Emotional and physical changes that are in sync with a woman’s menstrual cycle are usually a telltale sign.

The most important indication of PMS is the cyclic nature of symptoms. There is usually a symptom free time period 1 week after menstruation ends. At least 25% of patients do not have a symptom free time period; therefore, they should be evaluated for other medical or psychiatric conditions.

PMS can be treated in a variety of ways. The initial and usually most effective treatment involves non medical changes in diet and lifestyle.

Causes

Scientists have been unable to identify a single cause of PMS. Theories range from hormonal and chemical to nutritional and psychological. Women whose mother or sisters have PMS are more likely to have it, so there may be a genetic component. A combination of genetic, physiological, and environmental causes are likely.

Hormones and neurochemicals

The physical, emotional, and psychological changes that occur in PMS coincide with hormonal changes of the menstrual cycle. PMS may be a response to declining levels of estrogen and progesterone that occur just prior to menstruation. The exact role of the various hormones are not clear. Some neurochemicals (chemicals that help make up the nervous system) also have been implicated. Hormones and neurochemicals may interact to produce PMS.

Mineralocorticoids are a group of hormones that regulate the body’s fluids and electrolytes (e.g., sodium, potassium). Changing levels of mineralocorticoids may cause the bloated feeling that is common in women with PMS.

Prolactin stimulates breast development and the formation of milk during pregnancy and is associated with amenorrhea (abnormal absence of menstruation) and other gynecologic complications. Excess prolactin may cause the breast tenderness associated with PMS, although studies show that suppressing the secretion of excess prolactin does not relieve symptom.

Prostaglandins are hormone like substances that play a role in the luteal phase of the menstrual cycle, which occurs prior to bleeding. Changing levels of prostaglandins may be involved in PMS.

Serotonin and gamma-aminobutyric acid (GABA) are chemicals that relay signals from one nerve cell to the next (neurotransmitters). Low levels of serotonin have been linked to depression, and low levels of GABA are associated with anxiety, both symptoms of PMS.

Endorphins are neurochemicals that suppress pain and increase the threshold to painful stimuli. Low levels of endorphins may be involved in PMS.

Nutrition

Nutrition probably plays a causal role in PMS. Women can alleviate many symptoms by changing their diet. Eliminating certain foods or drinks often reduces symptoms to more tolerable levels.

Hypoglycemia (low blood sugar) afflicts many PMS sufferers. Some researchers speculate that the hypoglycemia is a precursor to PMS.

Depression

Because depression-related symptoms are prevalent in women who suffer PMS, there may be an underlying psychological condition that causes or contributes to PMS. Approximately 60% of women with major affective disorder (e.g., depression) also have PMS, and more than 30% of women who suffer chronic depression experience their first depressive episode during a time of significant hormonal change (e.g., premenstrually). In one study, between 57% and 100% of women who suffered PMS were found to have had at least one prior major depressive episode, compared to 0% to 20% of women without PMS.

However, PMS encompasses more than depression, and by focusing too much on this aspect, other important physiological factors may be overlooked.

Signs and Symptoms

PMS has been characterized by more than 150 symptoms, ranging from mood swings to weight gain to acne. The symptoms vary from woman to woman and cycle to cycle. For some women, the symptoms may be mild or moderate, and for others, they may be so severe as to be incapacitating.

Common symptoms include the following:

Mood-related ("affective") symptoms: depression, sadness, anxiety, anger, irritability, frequent and severe mood swings.

Mental process ("cognitive") symptoms: decreased concentration, indecision.

Pain: headache, breast tenderness, joint and muscle pain.

Nervous system symptoms: insomnia (sleeplessness), hypersomnia (sleeping for abnormally long periods of time), anorexia, food cravings, fatigue, lethargy, agitation, a change in sex drive, clumsiness, dizziness or vertigo, paresthesia (prickling or tingling sensation).

Gastrointestinal symptoms: nausea, diarrhea, palpitations (rapid fluttering of the heart), sweating.

Fluid and electrolyte symptoms: bloating, weight gain, oliguria (reduced urination).

Skin symptoms: acne, oily skin, greasy or dry hair.

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