Premenstrual Syndrome

Description

Alternative Names

Risk Factors

Premenstrual syndrome (PMS) is reported in women in many cultures worldwide. About 80% of women in their reproductive years experience some emotional and physical symptoms before their periods that impair daily activities. An estimated 30% of women feel they need treatment for symptoms. And, between 3% and 8% of women report very severe symptoms, notably premenstrual dysphoric disorder (PMDD). A number of factors may put a woman at higher risk for PMS.

Age

The risk for severe PMS is higher in younger women and onset usually begins around the mid-twenties. (In one survey of adolescents, however, 88% reported moderate to severe premenstrual symptoms.) In any case, women with PMS typically first seek treatment in their 30s.

Although some evidence has suggested that PMS symptoms diminish after age 35, a 2002 study reported that 6.4% of women between ages 36 and 44 had a diagnosis of premenstrual dysphoric disorder. Naturally, PMS and any manifestation of it end at menopause.

Psychologic Factors

Psychologic factors often play an important role in a woman's risk for PMS and premenstrual dysphoric disorder. It should be noted, however, that they are unlikely to be the causal role in most cases. One 1999 study treated women with PMS with only a placebo (a dummy pill). After three months, 20% of women experienced reduction of symptoms by more than half, and the benefits persisted in many of them. However, about 40% of women experienced only partial improvement and the other 40% did not improve at all. Nevertheless, studies continue to demonstrate that strong psychologic support can significantly reduce PMS symptoms.

Depression. One large study of women between 36 and 44, reported that 25% had symptoms indicative of major depression. Such women were significantly more likely to have PMS than those who were not depressed. Premenstrual dysphoric disorder can occur without any history or presence of major depression. Nevertheless, major depression is very common with PMDD.

Studies have specifically found a high prevalence of premenstrual dysphoric disorder in women who also suffer from seasonal affective disorder (SAD). This is a form of depression characterized by annual episodes of depression during fall or winter that remit in the spring or summer when daylight hours increase. In fact, some studies suggest that women with both may share genetic factors that make them vulnerable to these forms of depression.

Personality Factors Some people cite studies showing an increased incidence of low self-esteem in women who report severe premenstrual symptoms. They argue that perhaps most cases can be remedied with self-reassessment therapies that build confidence. (It is, of course, also possible that regular, physical symptoms that impair normal activities can have a significant negative effect on confidence.)

Cultural Factors

Studies indicate that women in diverse cultures experience premenstrual events differently and may a play role in their severity. For example, a study of Chinese women in Hong Kong reported that pain was the most significant PMS symptom, while depression predominated in Western women. A 2002 study of an American HMOs reported that women of Asian descent reported fewer PMS symptoms than their Caucasian counterparts, while Hispanic-American women reported more severe symptoms. Other studies have reported little difference between American and Northern European experiences of premenstrual symptoms and impact on daily life.

Other Factors Associated with PMS

Studies have found some factors associated with a higher risk for PMS, although there is no clear evidence that any of these are actual risk factors.

• In one study, women with more children were more likely to experience more severe symptoms than those with fewer children.
• Having a mother with PMS.
• Some studies have associated a high-sugar diet, consumption of large amounts of caffeine, and alcohol abuse with a high risk for PMS.
• Being sedentary.
• Stress may play a role in the severity of symptoms.
• A 2002 study reported that working outside the home was associated with a higher risk for premenstrual dysphoric disorder.