Premenstrual Syndrome (PMS)

Symptoms that occur several days before the onset, and sometimes during the first day of, menstruation.

Premenstrual syndrome (PMS) exhibits both physiological and psychological symptoms. The primary physiological symptoms are water retention and bloating, slightly enlarged and tender breasts, and food cravings. Psychological symptoms include irritability and depression. The full range of symptoms that have been attributed to PMS is extremely broad: as many as 150 have been identified. Because the symptoms are so varied from one woman to another (and even within the same woman at different times) it has been very difficult to arrive at a clinical definition of PMS. In addition, researchers disagree over whether PMS consists solely of symptoms that disappear completely at the onset of menstruation or of the premenstrual intensification of symptoms or conditions that are present, although to a lesser degree, during the rest of the month. Most women with premenstrual syndrome typically suffer from more than one symptom during each menstrual cycle.

Although there is no conclusive evidence that PMS is caused by hormone imbalances, some women have been successfully treated by hormonal therapy, which consists of oral contraceptives and monthly injections of progesterone. Recent research has linked premenstrual syndrome to an inadequate number of progesterone receptors or to the failure of those receptors to function properly, suggesting that PMS may be a disorder of progesterone response rather than progesterone deficiency. Other studies have posited a link between PMS and brain opioid (opiate-like) activity, based on alleged similarities between the symptoms of PMS and those of heroin withdrawal. Regular aerobic exercise, which helps stabilize opioid levels in the brain, has been shown to decrease PMS.

The physiological effects of PMS can be reduced through natural means, including stress management, dietary changes, acupressure massage, yoga, regular exercise, and adequate rest. Nutritional supplements, such as vitamins A, E, and B-6 have been shown to aid in the treatment of PMS, as have calcium and magnesium. Some physicians prescribe diuretics to treat water retention or tranquilizers for the treatment of irritability and mood swings. Recent research has suggested that drugs which increase the brain's serotonin levels, such Prozac, may also be helpful in treating PMS.

Although PMS has received much attention from the medical establishment, some women's health experts believe that its severity and significance have been exaggerated, and claim that only a small percentage of women have premenstrual symptoms so disabling that it interferes with work or other aspects of their lives. They also contend that the increased awareness of PMS contributes to a cultural bias that disproportionately attributes a woman's fluctuations in mood to her menstrual cycle, when the moods of both males and females will fluctuate within the course of a month for many reasons—both physiological and environmental—that have nothing to do with menstruation. In a recent investigation into the link between a woman's psychological characteristics and premenstrual syndrome, it was noted that whether or not women report PMS has less to do with the number and severity of their actual symptoms than with their general outlook on life, including levels of self-esteem and the ability to express feelings and manage stress.