Premenstrual syndrome (PMS) (historically called PMT or Premenstrual Tension) is a collection of physical, psychological, and emotional symptoms related to a woman's menstrual cycle. While most women of child-bearing age (about 80 percent) have some premenstrual symptoms,[1] Women with PMS have symptoms of "sufficient severity to interfere with some aspects of life".[2] Further, such symptoms are usually predictable and occur regularly during the two weeks prior to menses. The symptoms may vanish after the menstrual flow starts, but may continue even after the flow has begun. About 14 percent of women between the ages of 20 to 35 become so affected that they must stay home from school or work.[3]
For some women with PMS, the symptoms are so severe that they are considered disabling. This form of PMS has its own psychiatric designation: premenstrual dysphoric disorder (PMDD).
Culturally, the abbreviation PMS is widely understood in the United States to refer to difficulties associated with menses, and the abbreviation is used frequently even in casual and colloquial settings, without regard to medical rigor. In these contexts, the syndrome is rarely referred to without abbreviation, and the connotations of the reference are frequently more broad than the clinical definition.
PMS is a collection of symptoms. More than 200 different symptoms have been identified, but the three most prominent symptoms are irritability, tension, and dysphoria (unhappiness).[2] The exact symptoms and their intensity vary from woman to woman. Most women with premenstrual syndrome experience only a few of the problems. Other common symptoms are: [4] [5] [6] [7]
* Abdominal bloating
* Constipation and possible hemorrhoids due to water retention
* Abdominal cramps
* Breast tenderness or swelling
* Itching of the breasts
* Stress or anxiety
* Aggression
* Depression
* Appetite changes and food cravings
* Trouble falling asleep (insomnia)
* Joint or muscle pain
* Headache
* Fatigue
* Acne
* Trouble concentrating
* Body temperature increase
* Worsening of existing skin disorders, and respiratory (eg, allergies, infection) or eye (eg, visual disturbances, conjunctivitis) problems
When discussing PMS, the negative symptoms are often the only ones highlighted. There have been reports of positive aspects of this time in the menstrual cycle. Some women[attribution needed] claim that they have more energy and creativity premenstrually. Irritability and anger are often used to describe women with PMS. One view[attribution needed] suggests that women hold their anger in too often which can be harmful and they are able to effectively express their feeling during this time. In this light, PMS can be beneficial in some respects.
[edit] Risk Factors
* High caffeine intake[7]
* Stress may precipitate condition.
* Increasing age
* History of depression
* Tobacco use
* Family history
* Dietary Factors[8] (Low levels of certain vitamins and minerals, particularly magnesium, manganese, and vitamin E)
Family history is often a good predictor of the probability of premenstrual syndrome; studies have found that the occurrence of PMS is twice as high among identical twins compared with fraternal twins.[2] Although the presence of premenstrual syndrome is high among women with affective disorders such as depression and bipolar disorder,[citation needed] a causal relationship has not been established.
[edit] Diagnosis
There is no laboratory test or unique physical findings to verify the diagnosis of PMS. To establish a pattern, a woman's physician may ask her to keep a prospective record of her symptoms on a calendar for at least two menstrual cycles.[4] This will help to establish if the symptoms are, indeed, premenstrual and predictably recurring. A number of standardized instruments have been developed to describe PMS, including the Calendar of Premenstrual syndrome Experiences (COPE), the Prospective Record of the Impact and Severity of Menstruation (PRISM), and the Visual Analogue Scales (VAS).[2]
In addition, other conditions that may explain symptoms better must be excluded.[2] A number of medical conditions are subject to exacerbation at menstruation, a process called menstrual magnification. These conditions may lead the patient to believe that she may have PMS, when the underlying disorder may be some other problem. A key feature is that these conditions may also be present outside of the luteal phase. Conditions that can be magnified perimenstrually include depression, migraine, seizure disorders, chronic fatigue syndrome, irritable bowel syndrome, asthma, and allergies.[2]
Although there is no universal agreement about what qualifies as PMS, two definitions are commonly used in research programs:
* The National Institute of Mental Health research compares the intensity of symptoms from cycle days 5 to 10 to the six-day interval before the onset of menses.[2] To qualify as PMS, symptom intensity must increase at least 30% in the six days before menstruation. Additionally, this pattern must be documented for at least two consecutive cycles.
* The definition formulated at the University of California at San Diego requires both affective (emotional) and somatic (physical) symptoms during the five days before menses in each of three consecutive cycles, and must not be present during the pre-ovulatory part of the cycle (days 4 through 13).[2] For this definition, affective symptoms include symptoms like depression, angry outbursts, irritability, anxiety, confusion, and social withdrawal. Somatic symptoms include symptoms like breast tenderness, abdominal bloating, headache, and swelling of hands and feet.
