Premenstrual Syndrome (PMS)
From Encyclopedia of Sex and Sexuality
The cyclic appearance of psychological irritation, depression, and other symptoms during the luteal phase (after ovulation) of the menstrual cycle. This is the phase seven to fourteen days prior to menstruation. More than 150 symptoms have been associated with PMS, and many normal women who menstruate regularly have some of these symptoms to a greater or lesser degree.
The term PMS should be reserved for symptoms that are incapacitating enough to interfere with performance of daily activities. More common symptoms include severe mood swings, irritability, hostility, abdominal bloating, breast tenderness, changes in appetite, insomnia, headache, poor concentration, anxiety, crying spells, and edema (swelling) of the extremities. Preexisting conditions such as epilepsy and migraines can also be aggravated during the luteal phase of the menstrual cycle. Spontaneous ovulatory menstrual cycles must be present to diagnose PMS and the symptoms must occur during the luteal, or premenstrual, phase of the cycle.
Many causes of PMS have been suggested, including progesterone deficiency, fluid balance abnormalities, and nutritional deficiencies. However, there is no scientific evidence to unequivocally support any of these as the sole cause of PMS. Hormonal imbalance does not seem to play a role; actually the converse is true—a woman must have ovulatory cycles and therefore correct hormone levels to be diagnosed with PMS.
In order to determine whether she is experiencing PMS, a woman must keep a menstrual calendar with a record of her symptoms, correlating them with menstrual cycle phases. What is seen in PMS is an interval without symptoms during the follicular phase (preovulation), then symptoms, starting with ovulation. These continue until menstruation, when they disappear. If symptoms persist beyond menstruation, other disturbances must be considered, such as depression or anxiety disorders.
Many therapies have been proposed for PMS. No single treatment has been shown to be universally effective. Oral contraceptives eliminate the cyclic hormonal pattern and this improves some symptoms in some women; however, others experience PMS-like symptoms throughout the entire cycle when taking birth control pills. Vitamins and supplements of calcium and magnesium have been investigated, but their benefit is inconsistent and transient.
Some research has focused on the use of psychiatric medications in treating PMS, when mood and behavioral symptoms predominate. There are medications which can lessen irritability, anxiety, and depression, but the difficulty lies in the correct diagnosis. Are such women truly suffering from PMS, or do they have an underlying emotional disorder? Those with symptoms that are not cyclic should be referred for appropriate counseling and psychological evaluation. Alleviating some of the physical symptoms of PMS can also improve the quality of life for many sufferers. A mild diuretic can be used to reduce fluid retention and bloating, and anti-inflammatory agents can relieve pelvic and back pain. Stress reduction strategies are important in diminishing the symptoms of PMS. Exercise contributes to a sense of well-being which can lessen overall symptoms. Limiting salt and eliminating caffeine seem to lessen irritability and fluid retention.
Premenstrual syndrome remains a frustrating entity for both the health-seeker and the provider. Neither cause nor cure has been found; however, a combination of appropriate alterations in life-style and sympathetically addressing specific complaints will benefit the woman suffering from these symptoms.
