Premenstrual Syndrome

Premenstrual syndrome (PMS) refers to the cyclic recurrence of certain physical, psychological, and behavioral symptoms that begin about a week before the menstrual period and disappear within a few days after menstruation starts.

Although American women commonly say that they have PMS or are “PMSing” anytime they notice a cyclic change, the term PMS should only be used to describe the experience of symptoms that are severe enough to interfere with a woman's daily life. According to the National Institutes of Health, symptom intensity must increase at least 30 percent in the six days before menstruation, and this pattern must occur for at least two consecutive menstrual cycles for the symptoms to be called PMS.

PMS symptoms vary from woman to woman, and even from one menstrual cycle to another in some women. Self-help books for women with PMS sometimes list as many as 200 different possible symptoms, but most of these have not been clearly linked to menstrual cycle–related processes.

Among the more commonly reported physical symptoms are backache; bloating; edema (swelling, particularly in the hands, ankles, and feet); breast tenderness; fatigue; insomnia; constipation or diarrhea; appetite changes (e.g., cravings or overeating, loss of appetite); weight gain; acne; and changes in libido (e.g., feeling more or less sexy, increased or decreased sex drive). The more commonly reported psychological and behavioral symptoms include sadness, anxiety, irritability, mood swings, difficulty concentrating, increased sensitivity to rejection, decreased interest in work and social activities, and feeling overwhelmed.

PMS was originally known as premenstrual tension, and it was first described in 1931. However, it did not become well known until the 1980s, when PMS was used as a criminal defense in England. It is interesting to consider that before 1980 few women had even heard of PMS, yet, today, the term is so commonly used in the United States and other Western countries that most women think they have it. Researchers estimate that up to 85 percent of women will report premenstrual symptoms at some point during their childbearing years, but only a small percentage (3–5 percent) of women will experience [Page 1145]symptoms that are severe enough to interefere with daily functioning.

Some healthcare professionals and researchers have suggested that PMS is a culture-bound or socially constructed syndrome because it is not experienced in the same way around the world. For example, in China women are much more likely to complain of temperature changes than of emotional changes. PMS seems to be more common in cultures with negative and stigmatizing attitudes toward menstruation. Such a negative view leads women to consider normal physical and behavioral fluctuations to be symptoms of an illness and any stress, strain, nervousness, or unhappiness to be related to the menstrual cycle. In actuality, when most women chart their fluctuations, they find that there is not a cyclical pattern and that the symptoms are not actually severe enough to interfere with daily living. In addition, when men chart their moods and behaviors, they too find changes in energy, libido, and emotions throughout the month, but their changes are obviously not caused by a menstrual cycle or considered to be a medical problem.

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