What is PMS?

Premenstrual syndrome (PMS) is accompanied with a wide variety of symptoms, including premenstrual tension, weight gain, mood swings, tender breasts, food cravings, fatigue, irritability and depression. Because PMS is considered a worsening of the premenstrual molima of a woman’s cycle, it has been estimate that one or two of every four menstruating women experience some form of premenstrual syndrome. These symptoms can occur at any age but usually after age 14 or 15 and will disappear with menopause. The symptoms are often seen in women who have ovulation dysfunction and experience frequent miscarriages or difficulty in getting pregnant.

Symptoms tend to recur in a predictable pattern. However, some women will have symptoms only with the ovulation for 2 or 3 days, others 2-4 days before their period and some for 14-16 days before the menstrual period. On rare occasions, the physical and emotional changes one can experience with premenstrual syndrome may be particularly worse in some months and only slightly noticeable in others.

I have seen these symptoms so very intense to the point, in some cases, leading to child abuse, attempted suicide or homicide. Treatments and lifestyle adjustments can help one to reduce or manage the signs and symptoms of premenstrual syndrome. The most common signs and symptoms associated with premenstrual syndrome include:

Emotional and behavioral symptoms of PMS:

• Tension or anxiety
• Depressed mood
• Crying spells
• Mood swings and irritability or anger
• Appetite changes and food cravings
• Trouble falling asleep (insomnia)
• Social withdrawal
• Poor concentration
• Child abuse
• Attempted suicide (rare cases)
• Attempted homicide (rare cases)

Physical signs and symptoms of PMS:

• Joint or muscle pain
• Headache
• Fatigue
• Weight gain from fluid retention
• Abdominal bloating
• Breast tenderness
• Acne flare-ups
• Constipation or diarrhea

In most cases, a woman may experience several of these symptoms but not all. For years, women with PMS were reluctant to come forth and ask for help for fear that they would be considered to have a psychiatric problem. However, we begin to see more and more women feeling free to relate their symptoms to a health care provider. For some women, the physical pain and emotional stress are severe enough to affect their daily routines and activities. For most of these women, signs and symptoms disappear as the menstrual period begins and occasionally will continue for 2 to 4 days into the menstrual cycle.

However, some women with premenstrual syndrome have disabling symptoms every month. This form of PMS has its own psychiatric designation — premenstrual dysphoric disorder (PMDD). PMDD is a severe form of premenstrual syndrome with signs and symptoms including severe depression, feelings of hopelessness, anger, anxiety, low self-esteem, difficulty concentrating, irritability and tension. A number of women with severe PMS may have an underlying psychiatric disorder as well as a hormone deficiency.

“I had one of the most successful PMS clinics in Texas in the 1980’s. I found that women were afraid to admit they had all the debilitating symptoms of PMS for fear they were be consider to be “crazy” We allowed them to “come out of the closet” and be listened to. The majority of the women seen in my clinic had classic PMS symptoms to various degrees. We did find occasionally a problem with severe depression not related to PMS but made sure these women you seen by the proper provider.”

By: Joseph R. NBH MD, FACOG
Medical Director, NBH Lifetime Health Clinic

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