Description

• Premenstrual syndrome (PMS), also called late luteal phase disorder, is characterized by psychological and physical symptoms that occur cyclically and consistently during the second half of the menstrual cycle, which negatively impact usual activities of daily living and remit after the onset of menstruation.
• PMS is diagnosed through prospective symptom charting with symptoms present beginning at approximately day 13 of the cycle and resolving within 4 days of menses for two consecutive cycles.
  • At least one of the following symptoms must occur within 5 days of menses onset: breast tenderness, bloating/weight gain, headache, swelling of hands/feet, aches/pains, mood symptoms (depression, anger, irritability, anxiety, social withdrawal), poor concentration, sleep disturbance, or change in appetite.
• Premenstrual dysphoric disorder (PMDD) is the extreme variant of PMS; defined in DSM-5 as severe psychological symptoms causing significant dysfunctions in activity, which are not an exacerbation of symptoms of a chronic condition; have occurred in most cycles in the previous year; and are confirmed through prospective daily ratings of at least two symptomatic cycles
• Criteria for PMDD: at least five symptoms among the following, present in the final week before menses, and improving within a few days of onset of menses, with at least one of the symptoms being among the first four:
  • Depressed mood: feeling sad, hopeless, or self-deprecating
  • Anxiety or tension: feeling tense, anxious, or “on edge”
  • Affective lability: fluctuating emotions interspersed with frequent tearfulness
  • Irritability or anger: increased interpersonal conflicts
  • Decreased interest in usual activities, which may be associated with withdrawal from social relationships
  • Difficulty concentrating
  • Feeling fatigued, lethargic, or lacking in energy
  • Marked changes in appetite, which may be associated with binge eating or craving certain foods
  • Hypersomnia or insomnia
  • A subjective feeling of being overwhelmed or out of control
  • Physical symptoms such as breast tenderness/swelling, headaches, bloating or weight gain, arthralgias, or myalgias

Epidemiology

• Up to 75% of women experience some PMS symptoms at some time.
• Clinically significant PMS occurs in 3–8% of women.
• 2% of women have symptoms that interfere with their usual activities (PMDD).
• 14–88% of adolescent girls have moderate to severe PMS; one study demonstrated a 5.8% prevalence of PMDD in young women ages 14 to 24 years.

Risk Factors

• Age
  • More severe symptoms of PMDD may be seen in younger women.
• Culture
  • PMS/PMDD appear to be more prevalent in Western cultures, possibly due to differences in socialization and symptom expectations.
• Stress
  • PMS and PMDD may be associated with high levels of day-to-day stress and/or a history of stressful events, including sexual abuse.

Pathophysiology

• Occurrence of symptoms is related to ovarian function/ovulation:
  • PMS does not occur before menarche, during pregnancy, or after menopause.
  • PMS can occur after hysterectomy but not after bilateral oophorectomy.
  • Symptoms not observed during anovulatory cycles
• Research suggests altered cyclic interactions between sex hormones (particularly progesterone produced by corpus luteum), prostaglandins, and neurotransmitters including serotonin, γ-aminobutyric acid (GABA), and endogenous opioids.
• Women with PMS do not have abnormal serum concentrations of estrogen or progesterone or hormonal imbalance; women with PMS seem to have abnormal responses to normal variations in sex hormones.

Etiology

Etiology unknown but presumed to be multifactorial