Premenstrual Syndrome

The term premenstrual syndrome (PMS) refers to physical or emotional symptoms that appear in some women during the latter half of the menstrual cycle that can affect their relationships and/or ability to function. Estimates of PMS vary widely depending on how it is defined, but only a small number of women find it debilitating. In fact, although close to 75% of reproductive-aged women report premenstrual symptoms, less than 10% have symptoms that would necessitate a diagnosis of PMS (Born & Steiner, 2001; Elliott, 2002; Stanford, 2002).

Women who experience PMS often report feeling “out of control,” “sad,” and “cranky.” Their partners often do not understand how to handle their PMS, and many report not knowing what to say. Overall a woman who suffers from this syndrome needs a partner to take her symptoms seriously and be loving and supportive. Women who ex­perience PMS may also experience depression, insomnia, excessive sleepiness, restless­ness, and feelings of hopelessness (Strine et al., 2005).

The existence of PMS has been controversial. The term became well known in the early 1980s when two separate British courts reduced the sentences of women who had killed their husbands on the grounds that severe PMS reduced their capacity to control their behavior (Rittenhouse, 1991). Though this defense never succeeded in a U. S. trial, publicity over the British trials led to much discussion about PMS. Some women ob­jected to the idea of PMS, suggesting that it would reinforce the idea that women were “out of control” once a month and were slaves to their biology, whereas others supported it as an important biological justification of the symptoms they were experiencing each month. The extreme views of PMS have calmed down somewhat, and women who suf­fer from it can now find sympathetic physicians and a number of suggestions for coping strategies.

In 1994 the American Psychiatric Association introduced the diagnosis of premen — premenstrual dysphoric disorder (pmdd)

strual dysphoric disorder (PMDD), the most debilitating cases of PMS (Limosin & Ades, The most debllltatin9 and severe cases of pms.

2001) . PMDD is now listed in the DSM-IV-TR (American Psychiatric Association, 2000), the latest guide to the accepted disorders of the American Psychiatric Association. In or­der to accurately diagnose PMDD, a woman needs to chart her symptoms for at least two menstrual cycles to establish a typical pattern of symptoms (Born & Steiner, 2001; Elliott,

2002) .

There are four main areas of PMDD symptoms—mood, behavioral, somatic, and cognitive. Mood symptoms include depression, irritability, mood swings, sadness, and/or hostility. Behavioral symptoms include becoming argumentative, increased eating, and a decreased interest in activities. Somatic symptoms include abdominal bloating, fatigue, headaches, hot flashes, insomnia, backache, constipation, breast tenderness, and a crav­ing for carbohydrates. Cognitive symptoms include confusion and poor concentration.

PMDD symptoms seem to have both biological and lifestyle components, and so both medication and lifestyle changes can help.

PMDD is often blamed on serotonin dysregulation (Limosin & Ades, 2001).

Serotonin is a neurotransmitter in the brain that is involved in the expression of irritabil­ity, anger, depression, and specific food cravings. There is also some evidence that PMDD may have a genetic component—that is, it may run in families (Treloar et al., 2002).

Once documented, the first treatment for PMS or PMDD usually involves lifestyle changes. Dietary and vitamin/nutritional changes such as decreasing caffeine, salt, and alcohol intake; maintaining a low-fat diet; increasing calcium, magnesium, and vitamin E (to decrease negative mood and fluid retention); and taking primrose oil have been found to be helpful. Stress management, increased regular exercise, improved coping strategies, and drug therapy can also help (Stearns, 2001; Yonkers, 1999). It’s important to point out that these lifestyle changes would make the majority of us happier, regard­less of PMS!

One of the most promising pharmacological treatments has been the selective sero­tonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac; Pearlstein & Yonkers,

2002). Fluoxetine has yielded some promising results in the treatment of PMDD, al-

Question: My roommate has been on a strict diet (she might be anorexic), and recently she stopped having her periods. Could this be due to her eating disorder?

Absolutely. Once a woman drops below a certain percentage of body fat, she will cease to menstruate. This is common in women with eat­ing disorders or those who are malnourished because of starvation or disease. It also occurs in female athletes who train so hard that they reduce their body fat to a point below the critical level for menstruation. It is probably an evolutionary mecha­nism that prevents women from getting pregnant when there is too little food available to support the pregnancy. Over long periods of time, this loss of menstruation and ovula­tion can lead to infertility.

though it can cause side effects, such as headaches and sexual dysfunction (Carr & Ensom, 2002). Overall, the majority of women who suffer from PMS and PMDD do re­spond well to treatment (Stanford, 2002). Women who have a history of major depression, posttraumatic stress disorder, sex­ual abuse, or those who smoke cigarettes tend to be more at risk for developing PMS or PMDD (Koci, 2004; Cohen et al., 2002; Wittchen et al., 2002). In addition, ethnic vari­ations have also been found. For example, compared to Caucasian women, Hispanic women have been found to have more severe symptoms, whereas Asian women have less (Sternfeld et al., 2002).

posttraumatic stress disorder A stress disorder that follows a traumatic event, causing flashbacks, heightened anxiety, and sleeplessness.

ReviewQuestion Explain what is known about the existence of PMS/PMDD. What treatments are available?

menstrual manipulation The ability to plan and schedule the arrival of menstruation.

menstrual suppression The elimination of menstrual periods. intrauterine devices Devices that are inserted into the uterus for contraception. Progesterone IUDs often inhibit menstruation.

endometriosis The growth of endometrial tissue outside the uterus.

ReviewQuestion

Differentiate between menstrual manipulation and menstrual suppression.