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Premenstrual syndrome

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"PMS" redirects here. For other uses, see PMS (disambiguation).
Premenstrual syndrome
SpecialtyGynecology, psychiatry
SymptomsFatigue, irritability and other mood changes, tender breasts, abdominal bloating[1]
ComplicationsPremenstrual dysphoric disorder[1][2]
Usual onset1–2 weeks before menstruation[1]
Duration6 days[2]
CausesUnknown[1]
Risk factorsHigh-salt diet, alcohol, caffeine[1]
Diagnostic methodBased on symptoms[3]
TreatmentLifestyle changes, medication[1]
MedicationCalcium and vitamin D supplementation, NSAIDs, birth control pills[1][2]
Frequency~25% of menstruating people[2]

Premenstrual syndrome (PMS) is a disruptive set of emotional and physical symptoms that regularly occur in the one to two weeks before the start of each menstrual period.[4][5] Symptoms resolve around the time menstrual bleeding begins.[4] Different women experience different symptoms.[6] Premenstrual syndrome commonly produces one or more physical, emotional, or behavioral symptoms, that resolve with menses.[7] The range of symptoms is wide, and most commonly are breast tenderness, bloating, headache, mood swings, depression, anxiety, anger, and irritability. To be diagnosed as PMS, rather than a normal discomfort of the menstrual cycle, these symptoms must interfere with daily living, during two menstrual cycles of prospective recording.[7] These symptoms are nonspecific and are seen in women without PMS. Often PMS-related symptoms are present for about six days.[2] An individual's pattern of symptoms may change over time.[2] PMS does not produce symptoms during pregnancy or following menopause.[1]

Diagnosis requires a consistent pattern of emotional and physical symptoms occurring after ovulation and before menstruation to a degree that interferes with normal life.[3] Emotional symptoms must not be present during the initial part of the menstrual cycle.[3] A daily list of symptoms over a few months may help in diagnosis.[2] Other disorders that cause similar symptoms need to be excluded before a diagnosis is made.[2]

The cause of PMS is unknown, but the underlying mechanism is believed to involve changes in hormone levels during the course of the whole menstrual cycle.[1] Reducing salt, alcohol, caffeine, and stress, along with increasing exercise is typically all that is recommended for the management of mild symptoms.[1] Calcium and vitamin D supplementation may be useful in some.[2] Anti-inflammatory drugs such as ibuprofen or naproxen may help with physical symptoms.[1] In those with more significant symptoms, birth control pills or the diuretic spironolactone may be useful.[1][2]

Over 90% of women report having some premenstrual symptoms, such as bloating, headaches, and moodiness.[6] Premenstrual symptoms generally do not cause substantial disruption, and qualify as PMS in approximately 20% of pre-menopausal women.[4] Antidepressants of the selective serotonin reuptake inhibitors class may be used to treat the emotional symptoms of PMS.[4]

Premenstrual dysphoric disorder (PMDD) is a more severe condition that has greater psychological symptoms.[2][1] PMDD affects about 3% of women of child-bearing age.[4]

Signs and symptoms

Any disruptive, cyclical symptom could be a symptom of PMS, and some sources have suggested that the number of claimed symptoms could exceed even 200.[8] However, some symptoms are relatively common in PMS. Common emotional and non-specific symptoms include stress, anxiety, difficulty with sleep, headache, feeling tired, mood swings, increased emotional sensitivity, and changes in interest in sex.[9] Problems with concentration and memory may occur.[1] There may also be depression or anxiety.[1]

Common physical symptoms include bloating, breast tenderness, and headache.[7]

The exact symptoms and their intensity vary significantly from person to person, and even somewhat from cycle to cycle and over time.[2] Most people with premenstrual syndrome experience only a few of the possible symptoms, in a relatively predictable pattern.[10] Additionally, which symptoms are accepted as evidence of PMS varies by culture.[8] For example, women in China report feeling cold but do not report negative affect as part of PMS, while women in the US report negative affect but not feeling cold as part of PMS.[8]

The exclusion of certain symptoms associated with the menstrual cycle can pose a challenge for researchers. For example, period pain, which is extremely common, is excluded, as it does not appear until menstruation is beginning. However, any kind of pain can contribute to stress, difficulty with sleep, fatigue, irritability, and other symptoms that do count towards a PMS diagnosis.[8]

Causes

While PMS is linked to the luteal phase, the causes of PMS are not clear, but several factors may be involved. Changes in hormones during the menstrual cycle seem to be an important factor, with changing hormone levels affecting some more than others.[4] PMS occurs more often in those who are in their late 20s and early 40s, have at least one child, have a family history of depression, and have a past medical history of either postpartum depression or a mood disorder.[11]

Diagnosis

There are no laboratory tests or unique physical findings to verify the diagnosis of PMS. The three key features[3] are:

  • The chief complaint is one or more of the emotional symptoms associated with PMS. Irritability, tension, or unhappiness are typical emotional symptoms.
  • Symptoms appear predictably during the luteal (premenstrual) phase, reduce or disappear predictably shortly before or during menstruation, and remain absent during the follicular (pre-ovulatory) phase.
  • The symptoms must be severe enough to cause distress or interfere with everyday life.[4][5] Mild or occasional symptoms, which are extremely common, do not necessarily qualify as PMS.[5]

In 2016, the Royal College of Obstetricians and Gynaecologists argued that the definition of PMS should be changed to no longer require the presence of a psychological symptom.[8]

To document a pattern, potentially affected women may keep a prospective record of their symptoms on a calendar for at least two menstrual cycles.[8] This will help to establish if the symptoms are, indeed, limited to the premenstrual time, predictably recurring, and disruptive to normal functioning. 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).[3]

Other conditions that may better explain symptoms must be excluded.[3] A number of pre-existing medical conditions may be made worse at menstruation.[12] This is known as menstrual exacerbation or premenstrual magnification.[13] These conditions may lead women who do not have PMS to incorrectly believe that they have PMS, when the underlying disorder is some other medical problem, such as anemia, hypothyroidism, eating disorders and substance abuse.[3] 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.[3] Problems with other aspects of the female reproductive system must be excluded, including dysmenorrhea (period pain during menstruation, rather than before it),[8] endometriosis, perimenopause, and adverse effects produced by oral contraceptive pills.[3]

Severe symptoms may qualify as PMDD.[14]

The National Institute of Mental Health research definition compares the intensity of symptoms from cycle days 5 to 10 to the six-day interval before the onset of the menstrual period.[3] 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.

Management

Many treatments have been tried in PMS.[1] Reducing salt, caffeine, and stress along with increasing exercise is typically all that is recommended in those with mild symptoms.[1] Calcium and vitamin D supplementation may be useful in some.[2] Anti-inflammatories such as naproxen may help with physical symptoms.[1] A healthy diet, reduced consumption of salt, caffeine and alcohol, and regular exercise may be effective for women in controlling water retention.[unreliable medical source?][15] In those with more significant symptoms birth control pills may be useful.[3]

Diuretics have been used to handle water retention. Spironolactone has been shown in some studies to be useful.[16][3]

Antidepressants

Antidepressants in particular SSRIs are used as the first-line treatment of severe emotional symptoms of PMS, and also in treating PMDD.[17] Those with PMS may be able to take medication only on the days when symptoms are expected to occur.[18] Although intermittent therapy might be more acceptable to some, this might be less effective than continuous regimens.[19] Side effect such as nausea and weakness are however relatively common.[20]

Hormonal medications

Hormonal contraception is commonly used; common forms include the combined oral contraceptive pill and the contraceptive patch. This class of medication may cause PMS-related symptoms in some and may reduce physical symptoms in others.[3] They do not relieve emotional symptoms.[3]

Progesterone support has been used for many years but evidence of its efficacy is inadequate.[21]

Gonadotropin-releasing hormone agonists can be useful in severe forms of PMS but have their own set of significant potential side effects.

Alternative medicine

Tentative evidence supports vitamin B6 and chasteberry.[2] Data are insufficient to determine an effect of St. John's wort, soy, vitamin E, and saffron.[2] Evening primrose oil may be useful.[1]

One study was carried out on the treatment of PMS using acupressure and acupuncture, finding limited positive results but cautioning that the quality of evidence "ranged from low to very low quality" due to a small sample size and a lack of blinding, resulting in potential bias such as selective reporting.[22] The authors also note that no comparison was made with other proven treatments. Acupuncture is a pseudoscience,[23][24] and it has been characterized as quackery.[25][26][27]

Prognosis

PMS is generally a stable diagnosis, with susceptible individuals experiencing the same symptoms at the same intensity near the end of each cycle for years.[28] Treatment for specific symptoms is usually effective.

Even without treatment, symptoms tend to decrease in perimenopausal women.[29] However, those who experience PMS or PMDD are more likely to have significant symptoms associated with menopause, such as hot flashes.[2]

Epidemiology

Over 90% of women report having some premenstrual symptoms, such as bloating, headaches, and moodiness. Mostly the symptoms are mild.[6]

Globally, about 20% of women of reproductive age have PMS that disrupts their everyday lives.[4] Additionally, about 30% of women have mild or moderate symptoms related to their menstrual cycles that do not disrupt their everyday lives.[4]

Among females of reproductive age living in India, the prevalence of PMS is 43%, and in adolescents is even higher at almost 50%.[30]

History

PMS was originally seen as an imagined disease. Women who reported its symptoms were often told it was "all in their head".[31] Woman's reproductive organs were thought to control them. Women were warned not to divert needed energy away from the uterus and ovaries. This view of limited energy very quickly ran up against a reality in 19th-century America that young girls worked extremely long and hard hours in factories; newspapers in the 19th century were peppered with remedies to help in the "tyrannous processes" of the menstrual cycle. In 1873 Edward Clarke published an influential book titled Sex in Education. Clarke came to the conclusion that female operatives suffer less than schoolgirls because they "work their brain less". This suggested that they have stronger bodies and a reproductive "apparatus more normally constructed". Feminists later took opposition to Clarke's argument that women should not leave the private sphere by showing that women could function in the world outside the home in spite of natural body functions.[citation needed]

The first formal description of what is now called PMS as a medical problem, rather than a normal and natural variation, goes back to 1931, in a paper presented at the New York Academy of Medicine by Robert T. Frank titled "Hormonal Causes of Premenstrual Tension".[8] He incorrectly attributed premenstrual symptoms to an excess of the newly discovered sex hormone, estrogen.[8]

The specific name premenstrual syndrome first appeared in the medical literature in 1953.[8][32] At that time, medical researchers incorrectly thought that PMS was caused by a deficiency in progesterone.[8]

Since at least the 1990s, when PMDD became accepted, the definitions of PMS have focused on psychological symptoms.[8] Throughout the history of PMS, many of the symptoms associated with it have been stereotypical feminine behaviors, such as expressing emotions or "nagging".[8]

Since then, PMS has been a continuous presence in popular culture, occupying a place that is larger than the research attention accorded it as a medical diagnosis. Some have argued that women are partially responsible for the medicalization of PMS.[33] They claim that women are partially responsible for legitimizing this disorder and have thus contributed to the social construction of PMS as an illness.[33] The public debate over PMS and PMDD may have been affected by organizations who had a stake in the outcome including feminists, the American Psychiatric Association, physicians and scientists.[34]

Alternative views

Some supporters of PMS as a social construct believe PMDD and PMS to be unrelated issues: according to them, PMDD is a product of brain chemistry, and PMS is a product of culture, i.e. a culture-bound syndrome. Women are socially conditioned to expect PMS, or to at least know of its existence, and they therefore report their symptoms accordingly.[35][8] Becoming educated about PMS narrows their interpretation of their experiences by teaching them that certain symptoms are accepted as part of PMS, and that other symptoms are not, even though an accepted symptom might be unrelated to PMS for that woman (who might have a different medical condition), and an excluded symptom might be part of PMS, but not mentioned because they did not think it was relevant.[8] Social psychologist Carol Tavris also says that PMS is blamed as an explanation for rage or sadness.[35]

The identification of PMS as a medical disorder has been criticized as inappropriate medicalization.[8] These critics are concerned that society is pathologizing the menstrual cycle itself, even when the signs and symptoms are non-disruptive.[8]

The view of PMS as primarily a psychological situation, rather than primarily a biologically driven, medical condition dominated by physical symptoms, has also been criticized.[8] This view makes it harder to address psychosocial factors, such as external stress and a lack of social support, that exacerbate premenstrual symptoms.[8] Treating PMS as a psychological situation also makes it difficult to address menstrual exacerbation of other conditions, including catamenial epilepsy, menstrual migraine, and cyclical asthma.[8]

The limitation of PMS to premenstrual symptoms, rather than having a diagnosis that covers all symptoms associated with the menstrual cycle, has also been criticized.[8] Critics of this limitation think that excluding common physical symptoms that appear during the menstrual phase, such as period pain, fatigue, and back pain, is an arbitrary distinction that tends to reinforce the view of PMS as primarily an emotional problem, rather than a biological one.[8] They propose a focus on perimenstrual symptoms instead of strictly pre-menstrual ones.[8]

See also

References

  1. ^ a b c d e f g h i j k l m n o p q r s "Premenstrual syndrome (PMS) fact sheet". Office on Women's Health. December 23, 2014. Archived from the original on 28 June 2015. Retrieved 23 June 2015.
  2. ^ a b c d e f g h i j k l m n o p Biggs, WS; Demuth, RH (15 October 2011). "Premenstrual syndrome and premenstrual dysphoric disorder". American Family Physician. 84 (8): 918–24. PMID 22010771.
  3. ^ a b c d e f g h i j k l m n Dickerson, Lori M.; Mazyck, Pamela J.; Hunter, Melissa H. (2003). "Premenstrual Syndrome". American Family Physician. 67 (8): 1743–52. PMID 12725453. Archived from the original on 2008-05-13.
  4. ^ a b c d e f g h i Gudipally, Pratyusha R.; Sharma, Gyanendra K. (2022), "Premenstrual Syndrome", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32809533, retrieved 2023-01-31, Premenstrual syndrome (PMS) encompasses clinically significant somatic and psychological manifestations during the luteal phase of the menstrual cycle, leading to substantial distress and impairment in functional capacity.
  5. ^ a b c Mishra, Sanskriti; Elliott, Harold; Marwaha, Raman (2022), "Premenstrual Dysphoric Disorder", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30335340, retrieved 2023-01-31, While some discomfort prior to menses is quite common, premenstrual syndrome (PMS) includes the subset of women who experience symptoms that are severe enough to impact daily activities and functioning.
  6. ^ a b c "Premenstrual syndrome (PMS) | Office on Women's Health". www.womenshealth.gov. Retrieved 14 November 2022.
  7. ^ a b c Tiranini L, Nappi RE (2022). "Recent advances in understanding/management of premenstrual dysphoric disorder/premenstrual syndrome". Fac Rev. 11: 11. doi:10.12703/r/11-11. PMC 9066446. PMID 35574174.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  8. ^ a b c d e f g h i j k l m n o p q r s t u v w King, Sally (2020), Bobel, Chris; Winkler, Inga T.; Fahs, Breanne; Hasson, Katie Ann (eds.), "Premenstrual Syndrome (PMS) and the Myth of the Irrational Female", The Palgrave Handbook of Critical Menstruation Studies, Singapore: Palgrave Macmillan, ISBN 978-981-15-0613-0, PMID 33347177, retrieved 2023-01-31
  9. ^ "Merck Manual Professional - Menstrual Abnormalities". November 2005. Archived from the original on 2007-02-12. Retrieved 2007-02-02.
  10. ^ "MayoClinic.com: Premenstrual syndrome (PMS): Signs and symptoms". MayoClinic.com. 2006-10-27. Archived from the original on 2007-01-25. Retrieved 2007-02-02.
  11. ^ Myra S., Hunter (2007). Psychological Challenges in Obstetrics and Gynecology. Springer. pp. 255–262. ISBN 978-1-84628-807-4.
  12. ^ "Premenstrual Syndrome (PMS) - Gynecology and Obstetrics". MSD Manual Professional Edition. Retrieved 12 November 2022.
  13. ^ Connolly, Moira (November 2001). "Premenstrual syndrome: an update on definitions, diagnosis and management". Advances in Psychiatric Treatment. 7 (6): 469–477. doi:10.1192/apt.7.6.469. Retrieved 11 November 2022.
  14. ^ "Depression in women" (PDF). Retrieved 11 November 2022.
  15. ^ "Water retention: Relieve this premenstrual symptom". Mayo Clinic. Archived from the original on 25 September 2011. Retrieved 20 September 2011.
  16. ^ Wang, M.; Hammarbäck, S.; Lindhe, B. A.; Bäckström, T. (November 1995). "Treatment of premenstrual syndrome by spironolactone: a double-blind, placebo-controlled study". Acta Obstetricia et Gynecologica Scandinavica. 74 (10): 803–808. doi:10.3109/00016349509021201. ISSN 0001-6349. PMID 8533564. S2CID 46196112.
  17. ^ Hofmeister, Sabrina; Bodden, Seth (1 August 2016). "Premenstrual Syndrome and Premenstrual Dysphoric Disorder". American Family Physician. 94 (3): 236–240. PMID 27479626. Retrieved 15 November 2022.
  18. ^ "Low Doses Of Anti-depressant May Help Some Women Suffering From Moderate-to-severe PMS". Sciencedaily.com. 2006-10-14. Archived from the original on 2012-10-21. Retrieved 2012-12-25.
  19. ^ Shah, Nirav R.; Jones, J B.; Aperi, Jaclyn; Shemtov, Rachel; Karne, Anita; Borenstein, Jeff (2008). "Selective Serotonin Reuptake Inhibitors for Premenstrual Syndrome and Premenstrual Dysphoric Disorder". Obstetrics & Gynecology. 111 (5): 1175–82. doi:10.1097/AOG.0b013e31816fd73b. PMC 2670364. PMID 18448752.
  20. ^ Marjoribanks, Jane; Brown, Julie; O'Brien, Patrick Michael Shaughn; Wyatt, Katrina (Jun 7, 2013). "Selective serotonin reuptake inhibitors for premenstrual syndrome" (PDF). The Cochrane Database of Systematic Reviews. 2013 (6): CD001396. doi:10.1002/14651858.CD001396.pub3. PMC 7073417. PMID 23744611.
  21. ^ Ford, O; Lethaby, A; Roberts, H; Mol, BW (14 March 2012). "Progesterone for premenstrual syndrome". The Cochrane Database of Systematic Reviews. 2012 (3): CD003415. doi:10.1002/14651858.CD003415.pub4. PMC 7154383. PMID 22419287.
  22. ^ Armour, M; Ee, CC; Hao, J; Wilson, TM; Yao, SS; Smith, CA (14 August 2018). "Acupuncture and acupressure for premenstrual syndrome". The Cochrane Database of Systematic Reviews. 2018 (8): CD005290. doi:10.1002/14651858.CD005290.pub2. PMC 6513602. PMID 30105749.
  23. ^ Baran GR, Kiana MF, Samuel SP (2014). Chapter 2: Science, Pseudoscience, and Not Science: How Do They Differ?. Springer. pp. 19–57. doi:10.1007/978-1-4614-8541-4_2. ISBN 978-1-4614-8540-7. various pseudosciences maintain their popularity in our society: acupuncture, astrology, homeopathy, etc. {{cite book}}: |journal= ignored (help)
  24. ^ Good R (2012). Khine MS (ed.). Chapter 5: Why the Study of Pseudoscience Should Be Included in Nature of Science Studies. Springer. p. 103. ISBN 978-94-007-2457-0. Believing in something like chiropractic or acupuncture really can help relieve pain to a small degree [...] but many related claims of medical cures by these pseudosciences are bogus. {{cite book}}: |work= ignored (help)
  25. ^ Barrett, S (30 December 2007). "Be Wary of Acupuncture, Qigong, and "Chinese Medicine"". Quackwatch. Retrieved 4 May 2015.
  26. ^ Wang SM, Harris RE, Lin YC, Gan TJ (June 2013). "Acupuncture in 21st century anesthesia: is there a needle in the haystack?" (PDF). Anesthesia and Analgesia. 116 (6): 1356–59. doi:10.1213/ANE.0b013e31828f5efa. PMID 23709075. S2CID 1106695.
  27. ^ Gorski D (23 June 2014). "Ketogenic diet does not 'beat chemo for almost all cancers'". Science-Based Medicine. it is quite obvious that modalities such as homeopathy, acupuncture, reflexology, craniosacral therapy, Hulda Clark's "zapper," the Gerson therapy and Gonzalez protocol for cancer, and reiki (not to mention every other "energy healing" therapy) are the rankest quackery
  28. ^ Roca, CA; Schmidt, PJ; Rubinow, DR (1999). "A follow-up study of premenstrual syndrome". The Journal of Clinical Psychiatry. 60 (11): 763–6. doi:10.4088/JCP.v60n1108. PMID 10584765.
  29. ^ "LifeWatch - Women's Health - Women's Reproductive Health: PMS". Archived from the original on 2009-02-10. Retrieved 2008-01-13.
  30. ^ Dutta, Abhijit; Sharma, Avinash (2021). "Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in India: A systematic review and meta-analysis". Health Promotion Perspectives. 11 (2): 161–170. doi:10.34172/hpp.2021.20. ISSN 2228-6497. PMC 8233671. PMID 34195039.
  31. ^ Lane, Darina (2011-07-20). "The Curse of PMS" (PDF). Evening Echo. Thomas Crosbie Holdings. p. 11. Archived from the original (PDF) on 2013-12-05. Retrieved 2012-06-03.
  32. ^ Greene, Raymond and Katharina D. Dalton. (1953). "The Premenstrual Syndrome". British Medical Journal. 1 (4818): 1007–14. doi:10.1136/bmj.1.4818.1007. PMC 2016383. PMID 13032605.
  33. ^ a b Markens, Susan (1996). "The Problematic of 'Experience': A Political and Cultural Critique of PMS". Gender & Society. 10 (1): 42–58. doi:10.1177/089124396010001004. JSTOR 189552. S2CID 145424718.
  34. ^ Figert, Anne E. (1995). "The Three Faces of PMS: The Professional, Gendered, and Scientific Structuring of a Psychiatric Disorder". Social Problems. 42 (1): 56–73. doi:10.1525/sp.1995.42.1.03x0455m. JSTOR 3097005.
  35. ^ a b Carol Tavris, The Mismeasure of Woman (New York: Simon & Schuster, 1992), 142–144.
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