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Premenstrual Syndrome

Premenstrual syndrome, commonly referred to as PMS, is considered by many in the West to be a treatable medical condition characterized by complex physical and psychological/behavioral symptoms, cyclically affecting women of reproductive age. While the exact causes of premenstrual syndrome have yet to be established, existing theories suggest that it may result from a combination of hormonal changes or fluctuations, neurochemical changes within the brain, nutritional deficiencies, and/or stress. The duration and severity of PMS symptoms vary widely in women affected by the condition, but in general, symptoms begin anywhere from 1 to 2 weeks prior to menstruation and end within about 24 hours of the onset of menstruation. Treatment options include changes in diet and exercise, pharmacological solutions, psychotherapy, and stress reduction.

PMS: A Brief Diagnostic History

The complex of physical, psychological, and behavioral symptoms that have come to be characterized as PMS have been studied since the beginning of the 20th century. As early as 1931, American gynecologist R. T. Frank wrote an article in the Archives of Neurology and Psychiatry about a condition he called “premenstrual tension,” but it was not until the 1950s that the symptoms that have come to be known as PMS were given their current label. The term premenstrual syndrome was coined in 1953 by British physician and endocrinologist Katharina Dalton, who later established and ran a clinic for over 40 years at London's University College Hospital to treat PMS. Dalton believed that many women are prone to hormonal imbalances in the phase of the menstrual cycle directly preceding menstruation, resulting in progesterone deficiencies, and that progesterone treatment would aid in the reduction of tension and irritability in women reporting premenstrual symptoms. Though clinical trials have yielded mixed evidence with regard to progesterone treatments for PMS and they have not been universally accepted by the medical community, they still remain a treatment option today.

Despite several decades of research on the topic, there are still controversies over the definitions, causal agents, and diagnostic criteria for PMS. In the absence of medical consensus on its etiology and diagnostic pathway, psychiatric or gynecological PMS remains a loosely defined condition, lacking any standardized definition, diagnostic criteria, symptomology, or agreed-upon course of treatment.

Symptoms

Symptoms of premenstrual syndrome are wide-ranging— over 150 have been identified—and can be roughly divided into two categories: physical and psychological/behavioral. Physical symptoms typically include but are not limited to headaches, migraines, cramps, backache, bloating, constipation, diarrhea, weight gain, fatigue, fluid retention in the breasts and abdomen, acne, nausea, difficulty sleeping, and tenderness of the breasts. Psychological/behavioral symptoms include depression (ranging from mild to severe), tearfulness, difficulty concentrating, mood swings, anxiety, confusion, difficulty sleeping, lethargy, binge eating, irritability, anger/aggression, panic attacks, and loss of energy and/or sex drive. Most women who are affected by premenstrual syndrome experience only a subset of these symptoms, and those who experience symptoms are affected by them to varying degrees and for varying lengths of time. Of course, the list of symptoms is both wide-ranging and elastic, and many women may experience any number of these symptoms without being diagnosed as suffering from PMS. A typical indicator of the presence of PMS is a repeated, or cyclical, recurrence of symptoms on a monthly basis, usually 1 to 2 weeks prior to menstruation.

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