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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] 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. Image File history File links Question_book-3. ... Look up PMS in Wiktionary, the free dictionary. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // N00-N39 - Diseases of the genitourinary system: urinary system (N00-N08) Glomerular diseases Prefixes: .2 Diffuse membranous glomerulonephritis (N00) Acute nephritic syndrome (N01) Rapidly progressive nephritic syndrome (N02) Recurrent and persistent haematuria (N03) Chronic nephritic syndrome (N04) Nephrotic syndrome Lipoid nephrosis (N05) Unspecified nephritic syndrome (N06) Isolated proteinuria with specified... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Menstrual cycle In the female reproductive system, the menstrual cycle is a recurring cycle of physiologic changes that occurs in reproductive age females of several mammals, including human beings and other apes. ...

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). Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome, afflicting 8% of all women. ...

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.

Symptoms

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: ^{[3] [4] [5] [6]} Irritability is an excessive response to stimuli. ... Tension may mean: In physics, tension is a force related to the stretching of a string or a similar object. ... Look up dysphoria in Wiktionary, the free dictionary. ...

• 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
• High sexual arousal or desire^{[citation needed]}
• Trouble falling asleep (insomnia)
• Joint or muscle pain
• Headache
• Fatigue
• Acne
• Trouble concentrating
• Body temperature increase
• Extreme tearfulness
• Worsening of existing skin disorders, and respiratory (eg, allergies, infection) or eye (eg, visual disturbances, conjunctivitis) problems

Bloating is any abnormal general swelling, or increase in diameter of the abdominal area. ... Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. ... Hemorrhoids (also haemorrhoids or piles) are varicosities or swelling and inflammation of veins in the rectum and anus. ... In medical terms, stress is the disruption of homeostasis through physical or psychological stimuli. ... This article is about state anxiety. ... In psychology and other social and behavioral sciences, aggression refers to behavior that is intended to cause harm or pain. ... For other uses, see Depression. ... A food craving is an intense desire to consume a particular food, as opposed to food in general. ... This article is about the sleeping disorder. ... A headache (cephalgia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. ... Exhaustion redirects here. ... Grant Salzl has a huge nose full of acne. ...

Risk Factors

• High caffeine intake^[6]
• Stress may precipitate condition.
• Increasing age
• History of depression
• Tobacco use
• Family history
• Dietary Factors^[7] (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.

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.^[3] 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] On the Threshold of Eternity. ... Epilepsy (often referred to as a seizure disorder) is a chronic neurological condition characterized by recurrent unprovoked seizures. ... Chronic fatigue syndrome (CFS) is one of several names given to a poorly understood, highly debilitating disorder of uncertain cause/causes, which is thought to affect approximately 4 per 1,000 adults[1] in the United States and other countries, and a smaller fraction of children. ...

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.

Affective means having to do with emotion. ... The term somatic refers to the body, as distinct from some other entity, such as the mind. ...

Etiology

The exact causes of PMS are not fully understood. While PMS is linked to the luteal phase, measurements of sex hormone levels are within normal levels. PMS tends to be more common among twins suggesting the possibility of some genetic component.^[2] Current thinking suspects that central-nervous-system neurotransmitter interactions with sex hormones are affected.^[2] It is thought to be linked to activity of serotonin (a neurotransmitter) in the brain.^{[8] [5][9]} The luteal phase is the latter phase of the estrous cycle in animals. ... Sex hormones are hormones that affect the reproductive system. ... For the professional wrestling stable, see Ravens Nest#Serotonin. ...

Genetic factors also seem to play a role, as the concordance rate is two times higher in monozygotic twins than in dizygotic twins. ^[10]

Treatment

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). SSRI redirects here; for other uses, see SSRI (disambiguation). ...

• 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 exercise has been found in some studies to be helpful.^[2] Some PMS symptoms may be relieved by leading a healthy lifestyle: Reduction of caffeine, sugar, and sodium intake and increase of fiber, and adequate rest and sleep.^[11]

• Dietary intervention studies indicate that calcium supplementation (1200 mg/d) may be useful. Also vitamin E (400 IU/d) has shown some effectiveness.^[2] A number of other treatments have been suggested, although research on these treatments is inconclusive so far: Vitamin B6, magnesium, manganese and tryptophan.^[11]
• SSRIs have become the "initial drug of choice for severe PMS"^[2] The drug most widely studied is fluoxetine at doses of 20-60 mg/d. Other drugs include sertraline, paroxetine, clomipramine, fluvoxamine, and nefadozone.^[12] These drugs can also be given intermittently, that is when symptoms reappear.
• Hormonal intervention may take many forms:
  • Hormonal contraception is commonly used; common forms include the combined oral contraceptive pill and the contraceptive patch.
  • Progesterone support has been used for many years but evidence of its efficacy is inadequate.

• • Gonadotropin-releasing hormone agonists can be useful in severe forms of PMS but have their own set of significant potential side effects.
• Diuretics have been used to handle water retention. Spironolactone has been shown in some studies to be useful.^[2]
• Non-steroidal anti-inflammatory drugs (NSAIDs; eg ibuprofen) have been used.
• Evening Primrose Oil, which contains gamma-Linolenic acid (GLA), has been advocated but lacks scientific support.

Aerobic exercise refers to exercise that is of moderate intensity, undertaken for a long duration. ... For other uses, see Caffeine (disambiguation). ... This article is about sugar as food and as an important and widely-traded commodity. ... For sodium in the diet, see Salt. ... Fiber or fibre[1] is a class o f materials that are continuous filaments or are in discrete elongated pieces, similar to lengths of thread. ... For other uses, see Calcium (disambiguation). ... Tocopherol, or Vitamin E, is a fat-soluble vitamin in eight forms that is an important antioxidant. ... Pyridoxine Pyridoxal phosphate Vitamin B6 is a water-soluble vitamin. ... General Name, symbol, number magnesium, Mg, 12 Chemical series alkaline earth metals Group, period, block 2, 3, s Appearance silvery white solid at room temp Standard atomic weight 24. ... General Name, symbol, number manganese, Mn, 25 Chemical series transition metals Group, period, block 7, 4, d Appearance silvery metallic Standard atomic weight 54. ... Tryptophan (abbreviated as Trp or W)[1] is one of the 20 standard amino acids, which are the building blocks of proteins, and an essential amino acid in the human diet. ... Prozac redirects here. ... Zoloft bottles, with blue and green tablets Sertraline hydrochloride (also sold under brand names Zoloft, Lustral, Apo-Sertral, Asentra, Gladem, Serlift, Stimuloton, Xydep, Serlain, Concorz) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. ... Paroxetine (Paxil, Seroxat, Pexeva) is a selective serotonin reuptake inhibitor (SSRI) antidepressant. ... Clomipramine (brand-name Anafranil®) is a tricyclic antidepressant. ... Fluvoxamine (brand name as Luvox®, Faverin®, Fevarin® and Dumyrox®) is an antidepressant which functions pharmacologically as a selective serotonin reuptake inhibitor. ... Hormonal contraception refers to birth control methods that act on the hormonal system. ... The Pill redirects here. ... A contraceptive patch is a transdermal patch applied to the skin that releases synthetic estrogen and progestin hormones to prevent pregnancy. ... Progesterone is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species. ... A gonadotropin-releasing hormone agonist (GnRH agonist) is a synthetic peptide modeled after the hypothalamic neurohormone GnRH that interacts with its receptor to elicit its biologic response, the release of the pituitary hormones FSH and LH. Agonists do not quickly dissociate from the GnRH receptor. ... Spironolactone (marketed under the trade names Aldactone, Novo-Spiroton, Spiractin, Spirotone, or Berlactone) is a diuretic and is used as an antiandrogen. ... Wikipedia does not yet have an article with this exact name. ... Species Oenothera biennis Oenothera fruticosa Oenothera speciosa et al Oenothera is a genus of about 125 species of annual, biennial and perennial herbs. ... gamma-Linolenic acid (GLA) is an omega-6 essential fatty acid found primarily in vegetable oils. ...

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.^[13]

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.^[14]

Women who have PMS have an increased risk for clinical depression. On the Threshold of Eternity. ...

Epidemiology

The number of women who experience PMS depends entirely on the stringency of the definition of PMS.^[15] 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%^[16] to as high as 30%.^[15]

Mood symptoms such as emotional lability are both more consistent and more disabling than somatic symptoms such as bloating.^[17] 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.^{[citation needed]} 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 1980's.^{[citation needed]}

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.^[18] 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.^[19]

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 1980’s.^{[citation needed]} 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.^[20] Social scientists and literary scholars have claimed that many things are social constructions or social constructs, or that they have been socially constructed. ...

Supporters of PMS' medical validity claim support from the non-disputed status of a more serious but 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).^[21] PMDD also has a consistent treatment record with SSRIs, when compared with placebos.^[22] Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome, afflicting 8% of all women. ... Image of a typical positron emission tomography (PET) facility Positron emission tomography (PET) is a nuclear medicine medical imaging technique which produces a three-dimensional image or map of functional processes in the body. ... Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants for treating depression, anxiety disorders and some personality disorders. ...

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 hypochondriatic culture. There has not been enough debate between the two views to come to any sound conclusion.^{[citation needed]} Part of the reason the validity of the emotional aspects of PMS is being doubted is the lack of scientifically-sound studies on the matter. Many Western studies on PMS (PMS is primarily seen in Western Europe and North America) rely solely on self-reporting, and since Western women are socially conditioned to expect PMS or to at least know of its purported existence, they report their symptoms accordingly.^[23] For the anatomical term, see hypochondrium. ...

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. ^[24]

Controversies

Identifying natural female experiences as a disease in need of treatment is highly controversial especially because the implications for all women could be devastating.

Feminist scholars suggest that viewing PMS as a disease is born out of our patriarchal society. The symptoms that are associated with PMS are often in conflict with the way a woman "should" behave. Anger, irritability and increased sex drive are patterns of behavior that go against social norms for woman. Some people believe that PMS, along with other female-attributed disorders, are used to enforce gender stereotypes.^[25]

It is notable that the emergence of PMS as a disorder was created during a time when women's roles in society were changing. Particularly, women were beginning to enter the work force at increasing numbers. This coincidence has not been ignored especially among those who believe that PMS is used as a method of social control.

Multiple SSRI's have been used to treat PMS which is not without 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.^[26] Recently an oral contraceptive named Yaz has become the first and only birth control pill approved to treat PMDD. The marketing of Yaz centers on this aspect of the drug.

In some societies, this part of a women’s life is not seen in a negative way as is most often found in Western countries. The diagnosis and definition of PMS and PMDD are not universal across the world. The belief in PMS and its effects is mainly a Western creation. This is not to say that other places in the world deny the possibility that women are affected by their menstrual cycle but defining PMS in terms of a disease is specific to the West and the United States in particular. Official recognition of PMDD has only taken place in the U.S. The Food and Drug Administration (FDA) accepts PMDD as an illness but the World Health Organization (WHO) does not. In Europe, PMDD was forcibly taken off the list of indications for Prozac due to lack of supporting evidence for its effectiveness. Many of the symptoms of these two disorders are seen as negative in the U.S. and in need of treatment. This allows the medical system to become involved and regulate this part of women’s lives.^[27] WHO redirects here. ...

References

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External links

• National Association for Premenstrual Syndrome
• U.S. Department of Health & Human Services
• familydoctor.org
• MayoClinic.com at Mayo clinic
• Direct Online Health Encyclopaedia: Premenstrual syndrome (UK) at NHS
• "Premenstrual Syndrome (PMS) (Premenstrual Tension)" at Merck Manual
• usdoctor.com