Premenstrual syndrome (PMS) is a disruptive set of emotional and physical symptoms that regularly occur in the one to two weeks before the start of each menstrual period.
[7] The range of symptoms is wide, and most commonly are breast tenderness, bloating, headache, mood swings, depression, anxiety, anger, and irritability.
[1] Diagnosis requires a consistent pattern of emotional and physical symptoms occurring after ovulation and before menstruation to a degree that interferes with normal life.
[2] The cause of PMS is unknown, but the underlying mechanism is believed to involve changes in hormone levels during the course of the whole menstrual cycle.
[1] Reducing salt, alcohol, caffeine, and stress, along with increasing exercise is typically all that is recommended for the management of mild symptoms.
[6] Premenstrual symptoms generally do not cause substantial disruption, and qualify as PMS in approximately 20% of pre-menopausal women.
[4] Antidepressants of the selective serotonin reuptake inhibitors (SSRI) class may be used to treat the emotional symptoms of PMS.
However, any kind of pain can contribute to stress, difficulty with sleep, fatigue, irritability, and other symptoms that do count towards a PMS diagnosis.
However, the three key features are noted:[3] The National Institute of Mental Health research definition compares the intensity of symptoms from cycle days 5 to 10 to the six-day interval before the onset of the menstrual period.
[citation needed] In 2016, the Royal College of Obstetricians and Gynaecologists argued that the definition of PMS should be changed to no longer require the presence of a psychological symptom.
[8] To document a pattern, potentially affected individuals may keep a prospective record of their symptoms on a calendar for at least two menstrual cycles.
A number of standardized instruments have been developed to describe PMS, including the Calendar of Premenstrual syndrome Experiences (COPE), the Prospective Record of the Impact and Severity of Menstruation (PRISM), and the Visual Analogue Scales (VAS).
[3] Further, problems with other aspects of the female reproductive system must be excluded, including dysmenorrhea (period pain during menstruation, rather than before it),[8] endometriosis, perimenopause, and adverse effects produced by oral contraceptive pills.
[3][17] Gonadotropin-releasing hormone agonists can be useful in severe forms of PMS but have their own set of significant potential side effects, such as bone loss.
[17][18] Antidepressants, particularly SSRIs and venlafaxine, are used as the first-line treatment of severe emotional symptoms of PMS, and also in treating PMDD.
[17] PMS is generally a stable diagnosis, with susceptible individuals experiencing the same symptoms at the same intensity near the end of each cycle for years.
[4] Additionally, about 30% of women have mild or moderate symptoms related to their menstrual cycles that do not disrupt their everyday lives.
This view of limited energy very quickly ran up against a reality in 19th-century America that young girls worked extremely long and hard hours in factories; newspapers in the 19th century were peppered with remedies to help in the "tyrannous processes" of the menstrual cycle.
[24][25] The first formal description of what is now called PMS as a medical problem, rather than a normal and natural variation, goes back to 1931, in a paper presented at the New York Academy of Medicine by Robert T. Frank titled "Hormonal Causes of Premenstrual Tension".
[8] Since then, PMS has been a continuous presence in popular culture, occupying a place that is larger than the research attention accorded it as a medical diagnosis.
[27] The public debate over PMS and PMDD may have been affected by organizations who had a stake in the outcome including feminists, the American Psychiatric Association, physicians and scientists.
[8] This view makes it harder to address psychosocial factors, such as external stress and a lack of social support, that exacerbate premenstrual symptoms.
[30] Researchers are also working towards a single, uniform set of diagnostic criteria and to identify any objective characteristics that could be useful for diagnosis, such as any possible genetic predisposition.