Premenstrual Syndrome 

  • Author: Megan A Moreno, MD, MEd, MPH; Chief Editor: Andrea L Zuckerman, MD   more...
 
Updated: Mar 21, 2012
 

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]

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Pathophysiology

Incorrect older theories about the causes of PMS include an estrogen excess, estrogen withdrawal, progesterone deficiency, pyridoxine (vitamin B-6) deficiency,[3] 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.[4, 5, 6]
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Epidemiology

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.[7, 8, 9, 10]

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.[11]

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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 Professor of Pediatrics, Division of Adolescent Medicine, University of Washington; Director of Pediatric and Adolescent Gynecology, Seattle Children's Hospital; Medical Director of the King County Juvenile Detention Center Health Clinic; Medical Director of the Evevning Clinics at the Country Free Doctor FreeTeen Clinic for Homeless Youth

Ann E Giesel, MD is a member of the following medical societies: North American Society for Pediatric and Adolescent Gynecology, 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: Merck & Co. Inc Salary Employment

Specialty Editor Board

Elizabeth Alderman, MD  Director of Fellowship Training Program, Director of Adolescent Ambulatory Service, Professor of Clinical Pediatrics, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Children's Hospital at Montefiore

Elizabeth Alderman, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine

Disclosure: Merck Honoraria Speaking and teaching

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

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.

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.

References

  1. Freeman EW, Sondheimer SJ. Premenstrual Dysphoric Disorder: Recognition and Treatment. Primary Care Companion J Clin Psychiatry. 2003;5:30-9. [Medline].

  2. Yonkers KA, Brown C, Pearlstein TB, Foegh M, Sampson-Landers C, Rapkin A. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol. Sep 2005;106(3):492-501. [Medline].

  3. Fathizadeh N, Ebrahimi E, Valiani M, Tavakoli N, Yar MH. Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iran J Nurs Midwifery Res. Dec 2010;15:401-5. [Medline]. [Full Text].

  4. Emans SJ, Laufer MR, Goldstein DP. Premenstrual syndrome. In: Pediatric and Adolescent Gynecology. 5th ed. Philadelphia, PA: Lippincott-Raven Inc; 2005:461-7.

  5. Gehlert S, Chang CH, Hartlage S. Symptom patterns of premenstrual dysphoric disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders-IV. J Womens Health. Jan-Feb 1999;8(1):75-85. [Medline].

  6. Rossignol AM, Bonnlander H. Prevalence and severity of the premenstrual syndrome. Effects of foods and beverages that are sweet or high in sugar content. J Reprod Med. Feb 1991;36(2):131-6. [Medline].

  7. Bertone-Johnson ER, Hankinson SE, Johnson SR, Manson JE. Cigarette Smoking and the Development of Premenstrual Syndrome. American Journal of Epidemiology. Jun 2008;[Medline].

  8. Braverman PK. Premenstrual syndrome and premenstrual dysphoric disorder. J Pediatr Adolesc Gynecol. Feb 2007;20(1):3-12. [Medline].

  9. Deuster PA, Adera T, South-Paul J. Biological, social, and behavioral factors associated with premenstrual syndrome. Arch Fam Med. Mar-Apr 1999;8(2):122-8. [Medline].

  10. Masho SW, Adera T, South-Paul J. Obesity as a risk factor for premenstrual syndrome. J Psychosom Obstet Gynaecol. Mar 2005;26(1):33-9. [Medline].

  11. Cleckner-Smith CS, Doughty AS, Grossman JA. Premenstrual symptoms. Prevalence and severity in an adolescent sample. J Adolesc Health. May 1998;22(5):403-8. [Medline].

  12. Freeman EW, DeRubeis RJ, Rickels K. Reliability and validity of a daily diary for premenstrual syndrome. Psychiatry Res. Nov 15 1996;65(2):97-106. [Medline].

  13. Johnson, SR. Premenstrual syndrome, premenstrual dysphoric disorder, and beyond: a clinical primer for practitioners. Obstetrics and Gynecology. 2004;104:845-59. [Medline]. [Full Text].

  14. Steiner M, Korzekwa M, Lamont J, Wilkins A. Intermittent fluoxetine dosing in the treatment of women with premenstrual dysphoria. Psychopharmacol Bull. 1997;33(4):771-4. [Medline].

  15. Forrester-Knauss C, Zemp Stutz E, Weiss C, Tschudin S. The interrelation between premenstrual syndrome and major depression: results from a population-based sample. BMC Public Health. Oct 12 2011;11:795. [Medline]. [Full Text].

  16. Sanfillipo JS, Muram D, Dewhurst J. Pediatric and Adolescent Gynecology. 2nd ed. 2001:433-50.

  17. Freeman EW. Therapeutic management of premenstrual syndrome. Expert Opin Pharmacother. Dec 2010;11(17):2879-89. [Medline].

  18. Bertone-Johnson ER, Chocano-Bedoya PO, Zagarins SE, Micka AE, Ronnenberg AG. Dietary vitamin D intake, 25-hydroxyvitamin D3 levels and premenstrual syndrome in a college-aged population. J Steroid Biochem Mol Biol. Jul 2010;121(1-2):434-7. [Medline].

  19. Evans SM, Foltin RW, Fischman MW. Food "cravings" and the acute effects of alprazolam on food intake in women with premenstrual dysphoric disorder. Appetite. Jun 1999;32(3):331-49. [Medline].

  20. Girman A, Lee R, Kligler B. An integrative medicine approach to premenstrual syndrome. Am J Obstet Gynecol. May 2003;188(5 Suppl):S56-65. [Medline].

  21. Romano S, Judge R, Dillon J, et al. The role of fluoxetine in the treatment of premenstrual dysphoric disorder. Clin Ther. Apr 1999;21(4):615-33; discussion 613. [Medline].

  22. Jarvis CI, Lynch AM, Morin AK. Management strategies for premenstrual syndrome/premenstrual dysphoric disorder. Ann Pharmacother. Jul 2008;42(7):967-78. [Medline].

  23. Brown CS, Ling FW, Andersen RN, et al. Efficacy of depot leuprolide in premenstrual syndrome: effect of symptom severity and type in a controlled trial. Obstet Gynecol. Nov 1994;84(5):779-86. [Medline].

  24. Diegoli MS, da Fonseca AM, Diegoli CA, Pinotti JA. A double-blind trial of four medications to treat severe premenstrual syndrome. Int J Gynaecol Obstet. Jul 1998;62(1):63-7. [Medline].

  25. Freeman EW, Rickels K. Characteristics of placebo responses in medical treatment of premenstrual syndrome. Am J Psychiatry. Sep 1999;156(9):1403-8. [Medline].

  26. Freeman EW, Rickels K, Sondheimer SJ, et al. Nefazodone in the treatment of premenstrual syndrome: a preliminary study. J Clin Psychopharmacol. Jun 1994;14(3):180-6. [Medline].

  27. Jermain DM, Preece CK, Sykes RL, et al. Luteal phase sertraline treatment for premenstrual dysphoric disorder. Results of a double-blind, placebo-controlled, crossover study. Arch Fam Med. Jul-Aug 1999;8(4):328-32. [Medline].

  28. Pearlstein TB, Bachmann GA, Zacur HA, Yonkers KA. Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation. Contraception. Dec 2005;72(6):414-21. [Medline].

  29. Pearlstein TB, Stone AB, Lund SA, et al. Comparison of fluoxetine, bupropion, and placebo in the treatment of premenstrual dysphoric disorder. J Clin Psychopharmacol. Aug 1997;17(4):261-6. [Medline].

  30. Schmidt PJ, Nieman LK, Danaceau MA, et al. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med. Jan 22 1998;338(4):209-16. [Medline].

  31. Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. Jan 2006;163(1):41-7. [Medline]. [Full Text].

  32. Steinberg S, Annable L, Young SN, Liyanage N. A placebo-controlled clinical trial of L-tryptophan in premenstrual dysphoria. Biol Psychiatry. Feb 1 1999;45(3):313-20. [Medline].

  33. Steiner M, Macdougall M, Brown E. The premenstrual symptoms screening tool (PSST) for clinicians. Arch Women Ment Health. Aug 2003;6(3):203-9. [Medline].

  34. Stevinson C, Ernst E. Complementary/alternative therapies for premenstrual syndrome: a systematic review of randomized controlled trials. Am J Obstet Gynecol. Jul 2001;185(1):227-35. [Medline].

  35. Thys-Jacobs S, Starkey P, Bernstein D, Tian J. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study Group. Am J Obstet Gynecol. Aug 1998;179(2):444-52. [Medline].

  36. Walker AF, De Souza MC, Vickers MF, et al. Magnesium supplementation alleviates premenstrual symptoms of fluid retention. J Womens Health. Nov 1998;7(9):1157-65. [Medline].

  37. Wilson SA. Calcium therapy for treating PMS. J Fam Pract. Dec 1998;47(6):410-1. [Medline].

  38. Yakir M, Kreitler S, Brzezinski A, Vithoulkas G, Oberbaum M, Bentwich Z. Effects of homeopathic treatment in women with premenstrual syndrome: a pilot study. Br Homeopath J. Jul 2001;90(3):148-53. [Medline].

  39. Yonkers KA, Halbreich U, Freeman E. Symptomatic improvement of premenstrual dysphoric disorder with sertraline treatment. A randomized controlled trial. Sertraline Premenstrual Dysphoric Collaborative Study Group [see comments]. JAMA. Sep 24 1997;278(12):983-8. [Medline].

  40. Wyatt KM, Dimmock PW, Jones PW, Shaughn O'Brien PM. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review [see comments]. BMJ. May 22 1999;318(7195):1375-81. [Medline].

  41. Wyatt KM, Dimmock PW, O'Brien PM. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2002;CD001396. [Medline].

  42. Halbreich U. Selective serotonin reuptake inhibitors and initial oral contraceptives for the treatment of PMDD: effective but not enough. CNS Spectr. Jul 2008;13(7):566-72. [Medline].

  43. Steiner M, Steinberg S, Stewart D, et al. Fluoxetine in the treatment of premenstrual dysphoria. Canadian Fluoxetine/Premenstrual Dysphoria Collaborative Study Group. N Engl J Med. Jun 8 1995;332(23):1529-34. [Medline].

  44. Young SA, Hurt PH, Benedek DM, Howard RS. Treatment of premenstrual dysphoric disorder with sertraline during the luteal phase: a randomized, double-blind, placebo-controlled crossover trial. J Clin Psychiatry. Feb 1998;59(2):76-80. [Medline].

  45. Ford O, Lethaby A, Roberts H, Mol BW. Progesterone for premenstrual syndrome. Cochrane Database Syst Rev. Mar 14 2012;3:CD003415. [Medline].

  46. [Best Evidence] Agha-Hosseini M, Kashani L, Aleyaseen A, et al. Crocus sativus L. (saffron) in the treatment of premenstrual syndrome: a double-blind, randomised and placebo-controlled trial. BJOG. Mar 2008;115(4):515-9. [Medline].

  47. Budeiri D, Li Wan Po A, Dornan JC. Is evening primrose oil of value in the treatment of premenstrual syndrome?. ALYSIS. Feb 1996;17(1):60-8. [Medline].

  48. Chou PB, Morse CA, Xu H. A controlled trial of Chinese herbal medicine for premenstrual syndrome. J Psychosom Obstet Gynaecol. Feb 5 2008;1-8. [Medline].

  49. Freeman EW, Rickels K, Sondheimer SJ, Polansky M. Differential response to antidepressants in women with premenstrual syndrome/premenstrual dysphoric disorder: a randomized controlled trial. Arch Gen Psychiatry. Oct 1999;56(10):932-9. [Medline].

  50. Pearlstein T, Yonkers KA, Fayyad R, Gillespie JA. Pretreatment pattern of symptom expression in premenstrual dysphoric disorder. J Affect Disord. Apr 2005;85(3):275-82. [Medline].

  51. Seippel L, Backstrom T. Luteal-phase estradiol relates to symptom severity in patients with premenstrual syndrome. J Clin Endocrinol Metab. Jun 1998;83(6):1988-92. [Medline].

  52. Yonkers KA, O'Brien PM, Eriksson E. Premenstrual syndrome. Lancet. Apr 5 2008;371(9619):1200-10. [Medline].

 
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