PREMENSTRUAL SYNDROME. Ozgul Muneyyirci-Delale. Premenstrual Syndrome.
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Premenstrual Syndrome (PMS) is defined as “the cyclic recurrence in the luteal phase of the menstrual cycle of a combination of distressing physical, psychological, and/or behavioral changes of sufficient severity to result in deterioration of interpersonal relationships and/or interference with normal activities. Nearly 200 symptoms have been associated with this definition and it is the clustering of these signs and symptoms that is the hallmark of PMS.
The term “catamenial” is derived from the Greek and signifies around menses. In general an instance where a single recognized medical condition presented in the premenstruum was referred to as a catamenial disorder while a cluster of symptoms was referred to as PMS.
Many patients with psychiatric disorders also complain of worsening of their symptoms around the premenstrual phase, called “premenstrual magnification” (PMM).
Milder symptoms are believed to occur in about 30% to 80% of reproductive-age women, while severe symptoms are estimated to occur in 3% to 5% of menstruating women.
The concordance rate (if both twins have PMS) was found to be significantly higher in monozygous twins (93%) than dizygous twins (44%) and in non-twin control women (31%).
Women with PMS
SymptomShowing Symptoms (%)
Labile mood with alternating
sadness and anger 81
Crying spells 65
Social withdrawal 65
Difficulty concentrating 47
Abdominal bloating 90
Breast tenderness 85
Appetite changes and
food cravings 70
Swelling of the extremities 67
Gastrointestinal upset 48
A. Does not meet DSM-IV criteria but does meet ICD-10 criteria for PMS
B. Symptoms occur only in the luteal phase, peak shortly before menses, and cease with menstrual flow or soon after
C. Presence of one or more of the following symptoms
Mild psychological discomfort
Bloating and weight gain
Swelling of hands and feet
Aches and pains
Change in appetiteDiagnosis of PMS
A. At least five of the symptoms below, with at least one being a core symptom, are present a week before menses and remit a few days after onset of menses:
B. Symptoms must interfere with work, school, usual activities, or relationships
C. Symptoms must not merely be an exacerbation of
D. Criteria A, B and C must be confirmed by prospective daily ratings for at least two cycles