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Premenstrual Syndrome
(PMS)

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PMS vs. PMDD - Whats' the Difference?

Medical Author: Carolyn Janet Crandall, M.D., FACP
Medical Editors: Melissa Conrad Stöppler, MD and William C. Shiel Jr., MD, FACP, FACR

Ms. B.T. is 38 years old. Her co-workers always seem to know when she has her period. During this time, she becomes extremely irritable. She feels guilty because she gets very angry at her children for no logical reason or for apparently trivial reasons. In fact, one of her coworkers, with whom she is quite friendly, suggested she come in before her supervisor noticed problems on the job. She heard that there is a severe version of PMS that requires special treatment. Ms. B.T. wants to know if this is her problem.

Premenstrual syndrome (PMS) has been the term used for mood, and sometimes physical, symptoms that occur cyclically (predictably in relation to menses) in the second half of the menstrual cycle and interfere with a woman's quality of life. Some women experience even more severe symptoms. These women may have a conditions known as premenstrual dysphoric disorder (PMDD).

Premenstrual syndrome facts

  • Premenstrual syndrome (PMS) is a set of specific physical and psychological features.
  • Physical features include breast tenderness and bloating.
  • Psychological changes may include anger and depression.
  • PMS occurs in the last half of a woman's menstrual cycle.
  • The exact cause is unknown but is believed to be related to interactions between sex hormones and brain chemicals (neurotransmitters).
  • PMS can be mimicked and must be distinguished from other disorders.
  • The most helpful diagnostic tool for PMS is a menstrual diary.
  • Treatment options for PMS include exercise, a healthy lifestyle, emotional support of family and friends, and medications.
  • Possible for PMS include diuretics, pain killers, oral contraceptives, drugs that suppress ovarian function and antidepressants.

What is premenstrual syndrome?

Premenstrual syndrome (PMS) is a combination of emotional, physical, psychological, and mood disturbances that occur after a woman's ovulation and typically ending with the onset of her menstrual flow. The most common mood-related symptoms are irritability, depression, crying, oversensitivity, and mood swings with alternating sadness and anger. The most common physical symptoms are fatigue, bloating, breast tenderness (mastalgia), acne, and appetite changes with food cravings.

A more severe form of PMS, known as premenstrual dysphoric disorder (PMDD), also known as late luteal phase dysphoric disorder) occurs in a smaller number of women and leads to significant loss of function because of unusually severe symptoms. The American Psychiatric Association characterizes PMDD as a severe form of PMS in which anger, irritability, and anxiety or tension are especially prominent.

How common is PMS?

About 80% of women experience some premenstrual symptoms. The incidence of true PMS has often been overestimated by including all women who experience any physical or emotional symptoms prior to menstruation. It is estimated that clinically significant PMS (which is moderate to severe in intensity and affects a woman's functioning) occurs in 20% to 30% of women. About 2% to 6% of women are believed to have the more severe variant known as PMDD.

When was PMS discovered?

The mood changes surrounding this condition have been described as early as the time of the ancient Greeks. However, it was not until 1931 that this disorder was officially recognized by the medical community. The term "premenstrual syndrome" was coined in 1953.

What causes PMS?

PMS remains an enigma because of the wide-ranging symptoms and the difficulty in making a firm diagnosis. Several theories have been advanced to explain the cause of PMS. None of these theories have been proven, and specific treatment for PMS still largely lacks a solid scientific basis. Most evidence suggests that PMS results from the alterations in or interactions between the levels of sex hormones and brain chemicals known as neurotransmitters.

PMS does not appear to be specifically associated with any personality factors or specific personality types. Likewise, a number of studies have shown that psychological stress is not related to the severity of PMS.



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