Premenstrual Syndrome (PMS): Guide to Women's Health

T here is probably not a woman in the country who does not know what the initials PMS stand for; and few are the women who have been completely spared the physical and behavioral changes that characterize Premenstrual Syndrome (PMS). Estimates of the number of women affected by PMS vary widely. The American College of Obstetricians and Gynecologists suggests that 20 percent to 40 percent of women experience some premenstrual difficulties, with 5 percent affected significantly. Some medical experts maintain that up to 90 percent of American women experience one or more symptoms. Whatever the actual figures, women and their doctors agree that PMS is real.

PMS symptoms can begin anytime after ovulation, which occurs approximately 2 weeks before the start of your period. During the last three to 14 days of your cycle, you may notice a variety of changes in your body or disposition that can cause some degree of distress. These include:

• swelling and tenderness in the breasts;
• a “bloated” feeling or temporary weight gain of a few pounds;
• skin blemishes or acne;
• swelling of hands and feet;
• headaches;
• nausea or constipation, followed by diarrhea at the onset of menstruation;
• increased thirst or appetite;
• a craving for certain foods—especially sweets and items high in salt;
• increased irritability or mood swings;
• insomnia or fatigue;
• forgetfulness or confusion;
• feelings of anxiety or loss of control;
• sadness or uncontrolled crying.

Overall, more than 150 physical and behavioral symptoms have been associated with PMS. This complicates diagnosis and makes it difficult to classify the condition as a specific disease. And the mild premenstrual changes that many women experience have added to the confusion over PMS. Multiple severe symptoms that persist over a period of days, month after month, are more likely to be recognized as PMS than a single symptom or infrequent complaints. In addition, because the variety of symptoms and their causes are not well understood, doctors have no reliable method to determine who is susceptible to PMS, and why.

Unrelated medical problems can also mimic PMS and mislead you and your doctor. These include:

• fibrocystic breast changes, in which noncancerous lumps in the breast become swollen and painful;
• endometriosis, in which tissue from the lining of the uterus can cause pain elsewhere in the lower abdomen;
• unrecognized pelvic infections such as chlamydia;
• dysmenorrhea, or painful menstrual cramps, that can also prompt nausea and diarrhea;
• diabetes, which can cause excessive thirst or hunger;
• endocrine disorders such as an overactive thyroid;
• emotional disorders, which can be confused with the mood changes of PMS;
• allergies.

In recent years, PMS has generated a great deal of controversy in the media. While some physicians and researchers have portrayed nearly all women as suffering from PMS, generally the medical community acknowledges a significant difference between the more serious “syndrome” and the PMS “symptoms” experienced by many women.

Unfortunately, the politics of the debate have deflected attention from the very real difficulties caused by PMS. While some of the outbursts attributed to PMS have been casually dismissed as “raging hormones,” family, social, and work relationships may, indeed, suffer when a woman experiences the physical discomfort and emotional peaks and valleys of PMS. Truly violent tendencies, however, are usually caused by psychological or medical problems completely unrelated to PMS.

In fact, the most convincing evidence of PMS is its cyclical nature. All symptoms—both physical and behavioral—should disappear rapidly once menstruation begins. If physical changes continue for more than a few weeks or fail to subside once your period begins, it's important to contact your doctor to rule out other possible medical causes. Likewise, if you feel depressed premenstrually and your mood doesn't lift when your period starts, you should bring this to your doctor's attention.

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