eMedicine Specialties > Pediatrics: Surgery > Gynecology

Premenstrual Syndrome

Author: Megan A Moreno, MD, MEd, MPH, Assistant Professor, Department of Pediatrics, Section of Adolescent Medicine, University of Wisconsin-Madison School of Medicine and Public Health
Coauthor(s): Ann E Giesel, MD, Clinical Associate Professor, Division of General Pediatrics, Section on Adolescent Medicine, University of Washington; Cara Beth Rogers, University of Rochester; Liana Roxanne Clark, MD, Assistant Professor, Department of Pediatrics, Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia
Contributor Information and Disclosures

Updated: Apr 13, 2009

Introduction

Background

Premenstrual syndrome (PMS) is a recurrent luteal phase condition characterized by physical, psychological, and behavioral changes of sufficient severity to result in deterioration of interpersonal relationships and normal activity. Premenstrual dysphoric disorder (PMDD) is considered a severe form of PMS.1,2

Pathophysiology

Incorrect older theories about the causes of PMS include an estrogen excess, estrogen withdrawal, progesterone deficiency, pyridoxine (vitamin B-6) deficiency, alteration of glucose metabolism, and fluid-electrolyte imbalances. Current research provides some evidence supporting the following etiologies:

  • Serotonin deficiency is postulated because patients who are most affected by PMS have differences in serotonin levels. The symptoms of PMS can respond to selective serotonin reuptake inhibitors (SSRIs), which are medications that increase the amount of circulating serotonin.
  • Magnesium and calcium deficiencies are postulated as nutritional causes of PMS. Studies evaluating supplementation show improvement in physical and emotional symptoms.
  • Women with PMS often have an exaggerated response to normal hormonal changes. Although their levels of estrogen and progesterone are similar to women without PMS, rapid shifts in levels of these hormones promote pronounced emotional and physical responses.
  • Other theories under investigation include increased endorphins, alterations in the gamma-aminobutyric system (GABA), and hypoprolactinemia.3,4,5

Frequency

United States

Symptoms of PMS have been reported to affect as many as 90% of women of reproductive age sometime during their lives. Nearly 20% of women experience PMS; approximately 10% are affected severely. Studies indicate that 14-88% of adolescent girls have moderate-to-severe symptoms. Another 3-5% of women meet the criteria for PMDD. PMDD is reported to affect 3-8% of women of reproductive age.

Two risk factors for PMS are obesity and smoking. Research reveals that women with a body mass index (BMI) of 30 or above are nearly 3 times as likely to have PMS than women who are not obese. Women who smoke cigarettes are more than twice as likely to have more severe PMS symptoms.6,7,8,9

Mortality/Morbidity

Inability to maintain normal activities is part of the definition of this disease; hence, morbidity is related to loss of function.

Sex

By definition, females are affected.

Age

PMS affects women with ovulatory cycles. Older adolescents tend to have more severe symptoms than younger adolescents. Women in their fourth decade of life tend to be affected most severely. PMS completely resolves at menopause.10

Clinical

History

Elicit a description of cyclic symptoms that occur before the menstrual period and resolve with menses from patients with suspected premenstrual syndrome (PMS).

  • To establish the diagnosis, instruct patients to chart symptoms daily for 2 cycles. This usually demonstrates symptoms clustering around the luteal phase of ovulation, with resolution when menses begins.
  • Advise the patient to use a numeric scoring system (1 for mild, 2 for moderate, 3 for severe) when recording symptoms. Ask the patient to bring her lists to the next appointment.
  • Instruct the patient to rate their symptoms according to severity (1 for mild, 2 for moderate, and 3 for severe). The categories of PMS symptoms are as follows:11,12,9,13
    • PMS-A (anxiety)
      • Difficulty sleeping
      • Tense feelings
      • Irritability
      • Clumsiness
      • Mood swings
    • PMS-C (craving)
      • Headache
      • Cravings for sweet foods
      • Cravings for salty foods
      • Cravings for other types of food
    • PMS-D (depression)
      • Depression
      • Angry feelings for no reason
      • Feelings that are easily upset
      • Poor concentration or memory
      • Feelings of low self-worth
      • Violent feelings
    • PMS-H (hydration)
      • Weight gain
      • Abdominal bloating
      • Breast tenderness
      • Swelling of extremities
    • PMS-O (other)
      • Dysmenorrhea
      • Change in bowel habits
      • Frequent urination
      • Hot flashes or cold sweats
      • General aches or pains
      • Nausea
      • Acne
      • Allergic reactions
      • Upper respiratory infections

Physical

  • Usually, no physical findings are specifically helpful in establishing the diagnosis of PMS. If the adolescent presents during the luteal phase, she may have mastalgia or edema of the breasts or legs.12

Causes

  • The definitive cause of PMS is unknown.

More on Premenstrual Syndrome

Overview: Premenstrual Syndrome
Differential Diagnoses & Workup: Premenstrual Syndrome
Treatment & Medication: Premenstrual Syndrome
Follow-up: Premenstrual Syndrome
References
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References

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Further Reading

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Keywords

premenstrual syndrome, PMS, menstrual molimina, premenstrual tension, menses, period, menstrual period, menstruation, premenstrual dysphoric disorder, PMDD, PDD, hypoprolactinemia, obesity, smoking, mastalgia, edema, difficulty sleeping, tense feelings, irritability, clumsiness, mood swings, headaches, cravings, depression, weight gain, abdominal bloating, breast tenderness, dysmenorrhea, hot flashes, frequent urination, upper respiratory infection

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Contributor Information and Disclosures

Author

Megan A Moreno, MD, MEd, MPH, Assistant Professor, Department of Pediatrics, Section of Adolescent Medicine, University of Wisconsin-Madison School of Medicine and Public Health
Megan A Moreno, MD, MEd, MPH is a member of the following medical societies: Society for Adolescent Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Ann E Giesel, MD, Clinical Associate Professor, Division of General Pediatrics, Section on Adolescent Medicine, University of Washington
Ann E Giesel, MD is a member of the following medical societies: Society for Adolescent Medicine and Washington State Medical Association
Disclosure: Nothing to disclose.

Cara Beth Rogers, University of Rochester
Disclosure: Nothing to disclose.

Liana Roxanne Clark, MD, Assistant Professor, Department of Pediatrics, Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia
Liana Roxanne Clark, MD is a member of the following medical societies: American Academy of Pediatrics and Society for Adolescent Medicine
Disclosure: Nothing to disclose.

Medical Editor

Elizabeth Alderman, MD, Director of Fellowship Training Program, Director, Adolescent Ambulatory Service, Clinical Professor, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Montefiore Medical Center
Elizabeth Alderman, MD is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Andrea L Zuckerman, MD, Assistant Professor of Obstetrics/Gynecology and Pediatrics, Tufts University School of Medicine; Division Director, Pediatric and Adolescent Gynecology, Tufts Medical Center
Andrea L Zuckerman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, Massachusetts Medical Society, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine
Disclosure: Nothing to disclose.

 
 
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