Premenstrual stress syndrome
Encyclopedia
Premenstrual syndrome (PMS) (also called PMT or premenstrual tension) is a collection of physical and emotional symptoms related to a woman's menstrual cycle
. While most women of child-bearing age (up to 85%) report having experienced physical symptoms related to normal ovulatory function, such as bloating
or breast tenderness, medical definitions of PMS are limited to a consistent pattern of emotional and physical symptoms occurring only during the luteal phase
of the menstrual cycle that are of "sufficient severity to interfere with some aspects of life". In particular, emotional symptoms must be present consistently to diagnose PMS. The specific emotional and physical symptoms attributable to PMS vary from woman to woman, but each individual woman's pattern of symptoms is predictable, occurs consistently during the ten days prior to menses, and vanishes either shortly before or shortly after the start of menstrual flow.
Only a small percentage of women (2 to 5%) have significant premenstrual symptoms that are separate from the normal discomfort associated with menstruation in healthy women.
Culturally, the abbreviation PMS is widely understood in English-speaking countries 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.
Premenstrual dysphoric disorder
(PMDD) is a more severe condition, positioned as a psychiatric disorder similar to unipolar depression.
, tension, and dysphoria
(unhappiness). Common emotional and non-specific symptoms include stress
, anxiety
, difficulty in falling asleep (insomnia
), headache
, fatigue, mood swings, increased emotional sensitivity, and changes in libido. Formal definitions absolutely require the presence of emotional symptoms as the chief complaint
; the presence of exclusively physical symptoms associated with the menstrual cycle, such as bloating
, abdominal cramp
s, constipation
, swelling or tenderness in the breasts, cyclic acne
, and joint or muscle pain.
The exact symptoms and their intensity vary from woman to woman and even from cycle to cycle. Most women with premenstrual syndrome experience only a few of the possible symptoms, in a relatively predictable pattern. Under typical definitions, symptoms must be present at some point during the ten days immediately before the onset of menses, and must not be present for at least one week between the onset of menses and ovulation. Although the intensity of symptoms may vary somewhat, most definitions require that the woman's unique constellation of symptoms be present in multiple, consecutive cycles.
Family history is often a good predictor of the probability of premenstrual syndrome; studies have found that the concordance rate is two times higher among identical twins compared with fraternal twins. This means that if one twin has PMS, then the other twin is more likely than average to have PMS, and it suggests that the cause is partly genetic. Although the presence of premenstrual syndrome is high among women with affective disorders such as depression and bipolar disorder
, a causal relationship has not been established.
B vitamins
, in particular vitamin B6
, can also assist with 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. This will help to establish if the symptoms are, indeed, limited to the premenstrual time and are 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).
.
In addition, other conditions that may better explain symptoms must be excluded. 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 has PMS, when the underlying disorder may be some other problem, such as anemia
, hypothyroidism
, eating disorder
s and substance abuse
. A key feature is that these conditions may also be present outside of the luteal phase. Conditions that can be magnified perimenstrually include depression
or other affective disorders, migraine
, seizure disorders, fatigue, irritable bowel syndrome
, asthma
, and allergies. Also, problems with other aspects of the female reproductive system must be excluded, including dysmenorrhea
(pain during menses, rather than before it), endometriosis
, perimenopause, and adverse effects produced by oral contraceptive pills.
Although there is no universal agreement about what qualifies as PMS, two definitions are commonly used in research programs:
, measurements of sex hormone levels are within normal levels. In twin studies
, the concordance
of PMS is twice as high in monozygotic twins as in dizygotic twins, suggesting the possibility of some genetic component. Current thinking suspects that central-nervous-system neurotransmitter interactions with sex hormones are affected. It is thought to be linked to activity of serotonin
(a neurotransmitter) in the brain.
Preliminary studies suggest that up to 40% of women with symptoms of PMS have a significant decline in their circulating serum levels of beta-endorphin. Beta endorphin is a naturally occurring opioid neurotransmitter which has an affinity for the same receptor that is accessed by heroin and other opiates. Some researchers have noted similarities in symptom presentation between PMS symptoms and opiate withdrawal symptoms.
In one study of 71 women with PMS ,elevated levels of serum pseudocholinesterase were found. This enzyme is considered a possible marker for trait-anxiety .
A variety of evolutionary rationales for the syndrome have been offered, including that it is an epiphenomenon
due to the selective advantage accruing to other phases of the hormonal cycle, that it leads to "intensification of male ardour during the next onset of fertility", and that it prompts females to reject infertile males (who cause PMS due to not impregnating the female). "… an infertile male/potentially fertile female partnership would tend to break down, thus allowing a new pair-bond to be formed. The greater the degree of premenstrual hostility of the female, the sooner a fertile mating could ensue." Any theory would have to account for the persistence of PMS over substantial evolutionary time, as it appears to afflict baboons as well.
Treatment for specific symptoms is usually effective at controlling the symptoms. Even without treatment, symptoms tend to decrease in perimenopausal women, and disappear at menopause.
Women who have PMS have an increased risk for clinical depression
.
Mood symptoms such as emotional lability are both more consistent and more disabling than somatic symptoms such as bloating. A woman who experiences mood symptoms is likely to experience these symptoms consistently and predictably, whereas physical symptoms may come and go. Most women find that physical symptoms related to PMS are less disruptive than emotional symptoms
The study of PMS was brought about by many characters in society. Physicians and researchers study and treat recognized medical conditions. In order to have an impact, the existence, and importance of a disease needs to be socially accepted. Women have contributed to the rise of interest in PMS and society's acceptance of it as an illness. It is argued that women are partially responsible for the medicalization of PMS. By legitimizing this disorder, women have contributed to the social construction of PMS as an illness. It has also been suggested that the public debate over PMS and PMDD was impacted by organizations who had a stake in the outcome including feminists, the APA, physicians and scientists.
The study of PMS symptoms is not a new development. Debates about the definition and validity of this syndrome have a long history. As stated above, growing public attention was given to PMS starting in the 1980s. Up until this point, there was little research done surrounding PMS and it was not seen as a social problem. Through clinical trials and the work of feminists, viewing PMS in a social context had begun to take place.
Supporters of PMS' medical validity claim support from work on the similar problem, premenstrual dysphoric disorder
("PMDD"). In women with PMDD, studies have shown a correlation between self-reported emotional distress and levels of a serotonin precursor as measured by positron emission tomography
(PET). PMDD also has a consistent treatment record with SSRIs, when compared with placebos. However, the diagnosis has been controversial (including in regard to the pharmaceutical company influence, see below) and questioned on scientific grounds as medicalization
.
However, most supporters of PMS as a social construct do not dispute PMDD's medical status. Rather, they believe PMDD and PMS to be unrelated issues: one a product of brain chemistry, the other a product of a hypochondria
tic culture. Many Western studies on PMS rely solely on self-reporting. According to Carol Tavris
, Western women are socially conditioned to expect PMS or to at least know of its purported existence, and therefore they report their symptoms accordingly.
Another view holds that PMS is too frequently or wrongly diagnosed in many cases. A variety of problems, such as chronic depression, infections, and outbursts of frustration can be mis-diagnosed as PMS if they happen to coincide with the premenstrual period. Often, says this theory, PMS is used as an explanation for outbursts of rage or sadness, even when it is not the primary cause.
The use of multiple SSRI's to treat PMS has caused some controversy. The makers of Prozac began marketing the generic form, fluoxetine
, under the name Sarafem to treat PMS. This coincided with their loss of patent on Prozac, which has led to suggestions that their motivations are not completely benign. Recently an oral contraceptive named Drospirenone
(Yaz) has become the only birth control pill approved to treat PMDD. The marketing of Yaz centers on this aspect of the drug.
Menstrual cycle
The menstrual cycle is the scientific term for the physiological changes that can occur in fertile women for the purpose of sexual reproduction. This article focuses on the human menstrual cycle....
. While most women of child-bearing age (up to 85%) report having experienced physical symptoms related to normal ovulatory function, such as bloating
Bloating
Bloating is any abnormal general swelling, or increase in diameter of the abdominal area. As a symptom, the patient feels a full and tight abdomen, which may cause abdominal pain sometimes accompanied by increased borborygmus or more seriously the total lack of borborygmus.-Symptoms:The most common...
or breast tenderness, medical definitions of PMS are limited to a consistent pattern of emotional and physical symptoms occurring only during the luteal phase
Luteal phase
The luteal phase is the latter phase of the menstrual cycle or the estrous cycle . It begins with the formation of the corpus luteum and ends in either pregnancy or luteolysis...
of the menstrual cycle that are of "sufficient severity to interfere with some aspects of life". In particular, emotional symptoms must be present consistently to diagnose PMS. The specific emotional and physical symptoms attributable to PMS vary from woman to woman, but each individual woman's pattern of symptoms is predictable, occurs consistently during the ten days prior to menses, and vanishes either shortly before or shortly after the start of menstrual flow.
Only a small percentage of women (2 to 5%) have significant premenstrual symptoms that are separate from the normal discomfort associated with menstruation in healthy women.
Culturally, the abbreviation PMS is widely understood in English-speaking countries 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.
Premenstrual dysphoric disorder
Premenstrual dysphoric disorder
Premenstrual dysphoric disorder is a severe form of premenstrual syndrome, afflicting 3% to 8% of women. It is a diagnosis associated primarily with the luteal phase of the menstrual cycle...
(PMDD) is a more severe condition, positioned as a psychiatric disorder similar to unipolar depression.
Symptoms
More than 200 different symptoms have been associated with PMS, but the three most prominent symptoms are irritabilityIrritability
Irritability is an excessive response to stimuli. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimuli; It is usually used to refer to anger or frustration....
, tension, and dysphoria
Dysphoria
Dysphoria is medically recognized as a mental and emotional condition in which a person experiences intense feelings of depression, discontent and indifference to the world around them.Mood disorders can induce dysphoria, often with a heightened risk of suicide, especially in...
(unhappiness). Common emotional and non-specific symptoms include stress
Stress (medicine)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
, anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, difficulty in falling asleep (insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
), headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
, fatigue, mood swings, increased emotional sensitivity, and changes in libido. Formal definitions absolutely require the presence of emotional symptoms as the chief complaint
Chief complaint
The Chief Complaint formally known as CC in the medical field, or termed Presenting Complaint in the UK, is a concise statement describing the symptom, problem, condition, diagnosis, physician recommended return, or other factor that is the reason for a medicalencounter...
; the presence of exclusively physical symptoms associated with the menstrual cycle, such as bloating
Bloating
Bloating is any abnormal general swelling, or increase in diameter of the abdominal area. As a symptom, the patient feels a full and tight abdomen, which may cause abdominal pain sometimes accompanied by increased borborygmus or more seriously the total lack of borborygmus.-Symptoms:The most common...
, abdominal cramp
Cramp
Cramps are unpleasant, often painful sensations caused by muscle contraction or over shortening. Common causes of skeletal muscle cramps include muscle fatigue, low sodium, and low potassium...
s, constipation
Constipation
Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...
, swelling or tenderness in the breasts, cyclic acne
Acne
Acne is a general term used for acneiform eruptions. It is usually used as a synonym for acne vulgaris, but may also refer to:*Acne aestivalis*Acne conglobata*Acne cosmetica*Acne fulminans*Acne keloidalis nuchae*Acne mechanica...
, and joint or muscle pain.
The exact symptoms and their intensity vary from woman to woman and even from cycle to cycle. Most women with premenstrual syndrome experience only a few of the possible symptoms, in a relatively predictable pattern. Under typical definitions, symptoms must be present at some point during the ten days immediately before the onset of menses, and must not be present for at least one week between the onset of menses and ovulation. Although the intensity of symptoms may vary somewhat, most definitions require that the woman's unique constellation of symptoms be present in multiple, consecutive cycles.
Risk factors
- High caffeine intake
- Stress may precipitate condition
- Increasing age
- History of depressionDepression (mood)Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...
- Family history
- Dietary factors (Low levels of certain vitamins and minerals, particularly magnesiumMagnesiumMagnesium is a chemical element with the symbol Mg, atomic number 12, and common oxidation number +2. It is an alkaline earth metal and the eighth most abundant element in the Earth's crust and ninth in the known universe as a whole...
, manganeseManganeseManganese is a chemical element, designated by the symbol Mn. It has the atomic number 25. It is found as a free element in nature , and in many minerals...
, and vitamin EVitamin EVitamin E is used to refer to a group of fat-soluble compounds that include both tocopherols and tocotrienols. There are many different forms of vitamin E, of which γ-tocopherol is the most common in the North American diet. γ-Tocopherol can be found in corn oil, soybean oil, margarine and dressings...
) and also Vitamin DVitamin DVitamin D is a group of fat-soluble secosteroids. In humans, vitamin D is unique both because it functions as a prohormone and because the body can synthesize it when sun exposure is adequate ....
Family history is often a good predictor of the probability of premenstrual syndrome; studies have found that the concordance rate is two times higher among identical twins compared with fraternal twins. This means that if one twin has PMS, then the other twin is more likely than average to have PMS, and it suggests that the cause is partly genetic. Although the presence of premenstrual syndrome is high among women with affective disorders such as depression and bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
, a causal relationship has not been established.
B vitamins
B vitamins
B vitamins are a group of water-soluble vitamins that play important roles in cell metabolism. The B vitamins were once thought to be a single vitamin, referred to as vitamin B . Later research showed that they are chemically distinct vitamins that often coexist in the same foods...
, in particular vitamin B6
Vitamin B6
Vitamin B6 is a water-soluble vitamin and is part of the vitamin B complex group. Several forms of the vitamin are known, but pyridoxal phosphate is the active form and is a cofactor in many reactions of amino acid metabolism, including transamination, deamination, and decarboxylation...
, can also assist with PMS.
Diagnosis
There is no laboratory test or unique physical findings to verify the diagnosis of PMS. The three key features are:- The woman's chief complaint is one or more of the emotional symptoms associated with PMS (most typically irritability, tension, and/or unhappiness).
- Symptoms appear predictably during the luteal (premenstrual) phase, reduce or disappear predictably shortly before or during menstruation, and remain absent during the follicularFollicular phaseThe follicular phase is the phase of the estrous cycle, during which follicles in the ovary mature. It ends with ovulation. The main hormone controlling this stage is estradiol....
(pre-ovulatory) phase of the menstrual cycle. - The symptoms must be severe enough to disrupt or interfere with the woman's everyday life.
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. This will help to establish if the symptoms are, indeed, limited to the premenstrual time and are 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).
.
In addition, other conditions that may better explain symptoms must be excluded. 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 has PMS, when the underlying disorder may be some other problem, such as anemia
Anemia
Anemia is a decrease in number of red blood cells or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin...
, hypothyroidism
Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...
, eating disorder
Eating disorder
Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific...
s and substance abuse
Substance abuse
A substance-related disorder is an umbrella term used to describe several different conditions associated with several different substances .A substance related disorder is a condition in which an individual uses or abuses a...
. A key feature is that these conditions may also be present outside of the luteal phase. Conditions that can be magnified perimenstrually include depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
or other affective disorders, migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
, seizure disorders, fatigue, irritable bowel syndrome
Irritable bowel syndrome
Irritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...
, asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
, and allergies. Also, problems with other aspects of the female reproductive system must be excluded, including dysmenorrhea
Dysmenorrhea
Dysmenorrhea is a gynecological medical condition of pain during menstruation that interferes with daily activities, as defined by ACOG and others. Still, dysmenorrhea is often defined simply as menstrual pain, or at least menstrual pain that is excessive...
(pain during menses, rather than before it), endometriosis
Endometriosis
Endometriosis is a gynecological medical condition in which cells from the lining of the uterus appear and flourish outside the uterine cavity, most commonly on the ovaries. The uterine cavity is lined by endometrial cells, which are under the influence of female hormones...
, perimenopause, and adverse effects produced by oral contraceptive pills.
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. 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 somaticSomaticThe term somatic means 'of the body',, relating to the body. In medicine, somatic illness is bodily, not mental, illness. The term is often used in biology to refer to the cells of the body in contrast to the germ line cells which usually give rise to the gametes...
(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). 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.
Cause
The exact causes of PMS are not fully understood. While PMS is linked to the luteal phaseLuteal phase
The luteal phase is the latter phase of the menstrual cycle or the estrous cycle . It begins with the formation of the corpus luteum and ends in either pregnancy or luteolysis...
, measurements of sex hormone levels are within normal levels. In twin studies
Twin study
Twin studies help disentangle the relative importance of environmental and genetic influences on individual traits and behaviors. Twin research is considered a key tool in behavioral genetics and related fields...
, the concordance
Concordance (genetics)
Concordance as used in genetics usually means the presence of the same trait in both members of a pair of twins. However, the strict definition is the probability that a pair of individuals will both have a certain characteristic, given that one of the pair has the characteristic. For example,...
of PMS is twice as high in monozygotic twins as in dizygotic twins, suggesting the possibility of some genetic component. Current thinking suspects that central-nervous-system neurotransmitter interactions with sex hormones are affected. It is thought to be linked to activity of serotonin
Serotonin
Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...
(a neurotransmitter) in the brain.
Preliminary studies suggest that up to 40% of women with symptoms of PMS have a significant decline in their circulating serum levels of beta-endorphin. Beta endorphin is a naturally occurring opioid neurotransmitter which has an affinity for the same receptor that is accessed by heroin and other opiates. Some researchers have noted similarities in symptom presentation between PMS symptoms and opiate withdrawal symptoms.
In one study of 71 women with PMS ,elevated levels of serum pseudocholinesterase were found. This enzyme is considered a possible marker for trait-anxiety .
A variety of evolutionary rationales for the syndrome have been offered, including that it is an epiphenomenon
Epiphenomenon
An epiphenomenon is a secondary phenomenon that occurs alongside or in parallel to a primary phenomenon.-Medicine:...
due to the selective advantage accruing to other phases of the hormonal cycle, that it leads to "intensification of male ardour during the next onset of fertility", and that it prompts females to reject infertile males (who cause PMS due to not impregnating the female). "… an infertile male/potentially fertile female partnership would tend to break down, thus allowing a new pair-bond to be formed. The greater the degree of premenstrual hostility of the female, the sooner a fertile mating could ensue." Any theory would have to account for the persistence of PMS over substantial evolutionary time, as it appears to afflict baboons as well.
Management
Many treatments have been suggested for PMS, including diet or lifestyle changes, and other supportive means. Medical interventions are primarily concerned with hormonal intervention and use of selective serotonin reuptake inhibitors (SSRIs).- Supportive therapy includes evaluation, reassurance, and informational counseling, and is an important part of therapy in an attempt to help the patient regain control over her life. In addition, aerobic exerciseAerobic exerciseAerobic exercise is physical exercise of relatively low intensity that depends primarily on the aerobic energy-generating process. Aerobic literally means "living in air", and refers to the use of oxygen to adequately meet energy demands during exercise via aerobic metabolism...
has been found in some studies to be helpful. Some PMS symptoms may be relieved by leading a healthy lifestyle: Reduction of caffeineCaffeineCaffeine is a bitter, white crystalline xanthine alkaloid that acts as a stimulant drug. Caffeine is found in varying quantities in the seeds, leaves, and fruit of some plants, where it acts as a natural pesticide that paralyzes and kills certain insects feeding on the plants...
, sugarSugarSugar is a class of edible crystalline carbohydrates, mainly sucrose, lactose, and fructose, characterized by a sweet flavor.Sucrose in its refined form primarily comes from sugar cane and sugar beet...
, and sodiumSodiumSodium is a chemical element with the symbol Na and atomic number 11. It is a soft, silvery-white, highly reactive metal and is a member of the alkali metals; its only stable isotope is 23Na. It is an abundant element that exists in numerous minerals, most commonly as sodium chloride...
intake and increase of fiberFiberFiber is a class of materials that are continuous filaments or are in discrete elongated pieces, similar to lengths of thread.They are very important in the biology of both plants and animals, for holding tissues together....
, and adequate rest and sleep. - Dietary intervention studies indicate that calcium supplementationCalciumCalcium is the chemical element with the symbol Ca and atomic number 20. It has an atomic mass of 40.078 amu. Calcium is a soft gray alkaline earth metal, and is the fifth-most-abundant element by mass in the Earth's crust...
(1200 mg/d) may be useful. Also vitamin EVitamin EVitamin E is used to refer to a group of fat-soluble compounds that include both tocopherols and tocotrienols. There are many different forms of vitamin E, of which γ-tocopherol is the most common in the North American diet. γ-Tocopherol can be found in corn oil, soybean oil, margarine and dressings...
(400 IU/d) has shown some effectiveness. A number of other treatments have been suggested, although research on these treatments is inconclusive so far: Vitamin B6Vitamin B6Vitamin B6 is a water-soluble vitamin and is part of the vitamin B complex group. Several forms of the vitamin are known, but pyridoxal phosphate is the active form and is a cofactor in many reactions of amino acid metabolism, including transamination, deamination, and decarboxylation...
, magnesiumMagnesiumMagnesium is a chemical element with the symbol Mg, atomic number 12, and common oxidation number +2. It is an alkaline earth metal and the eighth most abundant element in the Earth's crust and ninth in the known universe as a whole...
, manganeseManganeseManganese is a chemical element, designated by the symbol Mn. It has the atomic number 25. It is found as a free element in nature , and in many minerals...
and tryptophanTryptophanTryptophan is one of the 20 standard amino acids, as well as an essential amino acid in the human diet. It is encoded in the standard genetic code as the codon UGG...
. - SSRIs can be used to treat severe PMS. Women with PMS may be able to take medication only on the days when symptoms are expected to occur. Although intermittent therapy might be more acceptable to some women, this might be less effective than continuous regimens.
- Hormonal intervention may take many forms:
- Hormonal contraceptionHormonal contraceptionHormonal contraception refers to birth control methods that act on the endocrine system. Almost all methods are composed of steroid hormones, although in India one selective estrogen receptor modulator is marketed as a contraceptive. The original hormonal method—the combined oral contraceptive...
is commonly used; common forms include the combined oral contraceptive pill and the contraceptive patchContraceptive patchA contraceptive patch is a transdermal patch applied to the skin that releases synthetic estrogen and progestin hormones to prevent pregnancy. They have been shown to be as effective as the combined oral contraceptive pill with perfect use, and the patch may be more effective in typical use.The...
. This class of medication may cause PMS-related symptoms in some women, and may reduce physical symptoms in other women. They do not relieve emotional symptoms. - ProgesteroneProgesteroneProgesterone also known as P4 is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy and embryogenesis of humans and other species...
support has been used for many years but evidence of its efficacy is inadequate. - Gonadotropin-releasing hormone agonistGonadotropin-releasing hormone agonistA gonadotropin-releasing hormone agonist is a synthetic peptide modeled after the hypothalamic neurohormone GnRH that interacts with the gonadotropin-releasing hormone receptor to elicit its biologic response, the release of the pituitary hormones FSH and LH.GnRH agonists are pregnancy category...
s can be useful in severe forms of PMS but have their own set of significant potential side effects.
- Hormonal contraception
- Diuretics have been used to handle water retention. SpironolactoneSpironolactoneSpironolactone , commonly referred to as simply spiro, is a diuretic and is used as an antiandrogen.It is a synthetic 17-lactone drug that is a renal competitive aldosterone antagonist in a class of pharmaceuticals called...
has been shown in some studies to be useful. - Non-steroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen) have been used to treat pain.
- Evening primrose oil, which contains gamma-Linolenic acidGamma-Linolenic acidγ-Linolenic acid is a fatty acid found primarily in vegetable oils...
(GLA), has been advocated but lacks scientific support. - ClonidineClonidineClonidine is a sympatholytic medication used to treat medical conditions, such as high blood pressure, some pain conditions, ADHD and anxiety/panic disorder...
has been reported to successfully treat a significant number of women whose PMS symptoms coincide with a steep decline in serum beta-endorphin on a monthly basis. - Chasteberry has been used by women for thousands of years to ease symptoms related to menstrual problems. It is believed some of the compounds found within Chasteberry work on the pituitary glandPituitary glandIn vertebrate anatomy the pituitary gland, or hypophysis, is an endocrine gland about the size of a pea and weighing 0.5 g , in humans. It is a protrusion off the bottom of the hypothalamus at the base of the brain, and rests in a small, bony cavity covered by a dural fold...
to balance hormone levels. - DL phenylalaninePhenylalaninePhenylalanine is an α-amino acid with the formula C6H5CH2CHCOOH. This essential amino acid is classified as nonpolar because of the hydrophobic nature of the benzyl side chain. L-Phenylalanine is an electrically neutral amino acid, one of the twenty common amino acids used to biochemically form...
can reduce or prevent symptoms of PMS in some women. It is only effective when the PMS is associated with an abrupt decline in circulating serum beta-endorphin levels. - Recent evidence suggests that daily treatment with St. Johns wort (Hypericum perforatum) may improve the most common physical and emotional symptoms associated with PMS.
Prognosis
PMS is generally a stable diagnosis, with susceptible women experiencing the same symptoms at the same intensity near the end of each cycle for years.Treatment for specific symptoms is usually effective at controlling the symptoms. Even without treatment, symptoms tend to decrease in perimenopausal women, and disappear at menopause.
Women who have PMS have an increased risk for clinical depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
.
Epidemiology
The number of women who experience PMS depends entirely on the stringency of the definition of PMS. While 80% of menstruating women have experienced at least one symptom that could be attributed to PMS, estimates of prevalence range from as low as 3% to as high as 30%.Mood symptoms such as emotional lability are both more consistent and more disabling than somatic symptoms such as bloating. A woman who experiences mood symptoms is likely to experience these symptoms consistently and predictably, whereas physical symptoms may come and go. Most women find that physical symptoms related to PMS are less disruptive than emotional symptoms
History
PMS was originally seen as an imagined disease. When women first started reporting these symptoms, they were often told it was "all in their head". Interest in PMS began to increase after it was used as a criminal defense in Britain during the early 1980s.The study of PMS was brought about by many characters in society. Physicians and researchers study and treat recognized medical conditions. In order to have an impact, the existence, and importance of a disease needs to be socially accepted. Women have contributed to the rise of interest in PMS and society's acceptance of it as an illness. It is argued that women are partially responsible for the medicalization of PMS. By legitimizing this disorder, women have contributed to the social construction of PMS as an illness. It has also been suggested that the public debate over PMS and PMDD was impacted by organizations who had a stake in the outcome including feminists, the APA, physicians and scientists.
The study of PMS symptoms is not a new development. Debates about the definition and validity of this syndrome have a long history. As stated above, growing public attention was given to PMS starting in the 1980s. Up until this point, there was little research done surrounding PMS and it was not seen as a social problem. Through clinical trials and the work of feminists, viewing PMS in a social context had begun to take place.
Alternative views
Some medical professionals suggest that PMS might be a socially constructed disorder.Supporters of PMS' medical validity claim support from work on the similar problem, premenstrual dysphoric disorder
Premenstrual dysphoric disorder
Premenstrual dysphoric disorder is a severe form of premenstrual syndrome, afflicting 3% to 8% of women. It is a diagnosis associated primarily with the luteal phase of the menstrual cycle...
("PMDD"). In women with PMDD, studies have shown a correlation between self-reported emotional distress and levels of a serotonin precursor as measured by positron emission tomography
Positron emission tomography
Positron emission tomography is nuclear medicine imaging technique that produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide , which is introduced into the body on a...
(PET). PMDD also has a consistent treatment record with SSRIs, when compared with placebos. However, the diagnosis has been controversial (including in regard to the pharmaceutical company influence, see below) and questioned on scientific grounds as medicalization
Medicalization
Medicalization is the process by which human conditions and problems come to be defined and treated as medical conditions and problems, and thus come under the authority of doctors and other health professionals to study, diagnose, prevent or treat...
.
However, most supporters of PMS as a social construct do not dispute PMDD's medical status. Rather, they believe PMDD and PMS to be unrelated issues: one a product of brain chemistry, the other a product of a hypochondria
Hypochondria
Hypochondriasis or hypochondria refers to excessive preoccupation or worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the body’s condition despite the absence of an actual medication condition...
tic culture. Many Western studies on PMS rely solely on self-reporting. According to Carol Tavris
Carol Tavris
Carol Anne Tavris is an American social psychologist and author. She received a Ph.D. in social psychology from the University of Michigan, and has taught psychology at the University of California, Los Angeles and the New School for Social Research...
, Western women are socially conditioned to expect PMS or to at least know of its purported existence, and therefore they report their symptoms accordingly.
Another view holds that PMS is too frequently or wrongly diagnosed in many cases. A variety of problems, such as chronic depression, infections, and outbursts of frustration can be mis-diagnosed as PMS if they happen to coincide with the premenstrual period. Often, says this theory, PMS is used as an explanation for outbursts of rage or sadness, even when it is not the primary cause.
The use of multiple SSRI's to treat PMS has caused some controversy. The makers of Prozac began marketing the generic form, fluoxetine
Fluoxetine
Fluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. It is manufactured and marketed by Eli Lilly and Company...
, under the name Sarafem to treat PMS. This coincided with their loss of patent on Prozac, which has led to suggestions that their motivations are not completely benign. Recently an oral contraceptive named Drospirenone
Drospirenone
Drospirenone is an anti-androgenic synthetic progestin that is typically used in birth control. There have been concerns raised regarding its safety and is thus not recommended as a first line agent.- Medical uses :...
(Yaz) has become the only birth control pill approved to treat PMDD. The marketing of Yaz centers on this aspect of the drug.
External links
- National Association for Premenstrual Syndrome
- U.S. Department of Health & Human Services
- familydoctor.org
- MayoClinic.com at Mayo clinicMayo ClinicMayo Clinic is a not-for-profit medical practice and medical research group specializing in treating difficult patients . Patients are referred to Mayo Clinic from across the U.S. and the world, and it is known for innovative and effective treatments. Mayo Clinic is known for being at the top of...
- Direct Online Health Encyclopaedia: Premenstrual syndrome (UK) at NHSNational Health ServiceThe National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
- "Premenstrual Syndrome (PMS) (Premenstrual Tension)" at Merck Manual