Premenstrual Syndrome - Risk Factors

Symptoms

Nearly every woman at some point has some symptoms as menstruation approaches. For about half of these women, symptoms are mild and do not affect normal daily life. The other half report symptoms severe enough to impair daily life and relationships. Between 3 - 8% of women report extremely severe symptoms.

In general, premenstrual syndrome (PMS) is a set of physical, emotional, and behavioral symptoms that occur during the last week of the luteal phase (1 - 2 weeks before menstruation) in most cycles. The symptoms typically go away within 4 days after bleeding starts and do not start again until at least day 13 in the cycle. Once established, the symptoms tend to remain fairly constant until menopause, although they can vary from cycle to cycle.

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Physical Symptoms

• Breast engorgement and tenderness
• Abdominal bloating
• Fluid retention
• Increased appetite, often with specific food cravings (especially salt and sugar)
• Weight gain
• Skin problems (acne)
• Headache and migraine (migraine may increase severity of PMS symptoms)
• Muscle and joint aches or pains

Emotional and Behavioral Symptoms

• Depression
• Anxiety and tension
• Insomnia or oversleeping
• Change in sexual interest and desire (although some women lose interest, others have a heightened drive)
• Irritability
• Hostility and outbursts of anger (in severe cases, violence toward self and others)
• Mood swings
• Inability to concentrate and some memory loss
• Crying
• Lethargy, fatigue, and lack of energy

Premenstrual Dysphoric Disorder

The American Psychiatric Association has specific criteria that defines premenstrual dysphoric disorder (PMDD). PMDD is a condition marked by severe depression, irritability, and tension before menstruation. PMDD has features of both anxiety and depression disorders.

Diagnostic Criteria. Symptoms must occur during the last week of the premenstrual (luteal) phase in most menstrual cycles. They should resolve within a few days after the period starts. They should markedly interfere with work or social functioning. Also, symptoms should not just be those of another underlying disorder.