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Premenstrual Syndrome (PMS)


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Introduction
Premenstrual syndrome (PMS) is a cluster of physical and emotional symptoms associated with the menstrual cycle. Most women experience some degree of PMS at some point in their menstrual history, although symptoms vary significantly from woman to woman. Reproductive hormones and neurotransmitters are thought to play a central role in the etiology of PMS. Five to ten days prior to menses, plasma estrogens rise and progesterone levels decline. These changes are accompanied by an increase in follicle stimulating hormone (FSH) six to nine days prior to menstruation, and peak aldosterone levels two to eight days before menstruation. Prolactin levels are elevated in most PMS patients. Other biochemical pathways such as the insulin response, and uptake of vitamins and minerals are being studied as potential causative factors. One hypothesis suggests that PMS may be due to an aberration in blood viscosity and red blood cell hydration during the menstrual cycle.(1)

Premenstrual dysphoric disorder (PMDD) is a condition associated with severe emotional and physical problems that are linked closely to the menstrual cycle and is considered a very severe form of PMS. One brain chemical that may be especially important is serotonin, a neurotransmitter. The serotonin system has a close relationship to the female hormones, and imbalances of the serotonin system may play an important role in causing PMDD. Symptoms occur a week before menstruation and ends after bleeding starts. In order to be diagnosed with PMDD, you must have at least 5 of these symptoms.(2)

  • feelings of sadness or despair, or possibly suicidal thoughts
  • feelings of tension or anxiety
  • panic attacks
  • mood swings, crying
  • lasting irritability or anger that affects other people
  • disinterest in daily activities and relationships
  • trouble thinking or focusing
  • tiredness or low energy
  • food cravings or binge eating
  • having trouble sleeping
  • feeling out of control
  • physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain
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Footnotes
1 Simpson LO. The etiopathologies of premenstrual syndrome as a consequence of altered blood rheology: A new hypothesis. Med Hypothesis. 1988;25(4).
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2 National Women's Health Information Center, U.S. Department of Health and Human Services, Sep2006. http://www.womenshealth.gov/faq/pms.htm
 
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