What Is PMS? (a detailed overview of the syndrome)

Definition | History | PMS Symptoms | Types of PMS | Causes of PMS

Introduction to PMS

Your hair’s gone limp, your face is breaking out and your pants just aren’t fitting the way they’re supposed to. Last week you were on top of the world but today all you want to do is crawl under the covers and hide. For most women, these days mean one thing–your period is on its way.

Premenstrual syndrome, otherwise known as PMS has been around since the days of Hippocrates and it is estimated that up to 70% of women suffer from PMS during their reproductive years. For some women, it may not be a severe problem, but for many it is a monthly debilitating ordeal; and may even lead to time off work. Some sources have recorded up to 150 symptoms attributable to premenstrual disorder.

Dr Marylin Glenville says that personality changes associated with this time can be very severe, with some women describing a Jekyll and Hyde change where they literally become a different person pre-menstrually. Women say that they know they are feeling and thinking differently to the point of being irrational but they have no control over those changes. For some women at that time the world seems completely negative, ‘everything seems black’, doom and gloom and they will often cry at the slightest thing without any real reason.

The explanation centres around our hormones. Three hormones drive our monthly cycles—oestrogen, progesterone and Luteinizing hormone. In the first two weeks following our periods, we’re at our best. Oestrogen levels rise, our skin clears, our hair shines and we feel pretty darn good. But all that changes mid-cycle at the time of ovulation.

“For a regular 28 day cycle, the Luteinizing hormone spikes on day 14, which causes the egg to rupture through the wall of the ovary,” says Iris Prager, Ph.D., educational manager of P&G and an expert on premenstrual changes and puberty.

The time of ovulation marks the beginning of the premenstrual phase. If an egg isn’t fertilized, progesterone and oestrogen levels fall as the lining of the uterus weakens and is shed. “This spike and then drop in progesterone combined with low levels of oestrogen can cause changes in appearance. You may start to see blemishes and your hair seems more oily,” says Prager. “You may also feel bloated, experience sore breasts and a variety of mood problems, including depression, anxiety and/or irritability.”

Definition of PMS

According to Wikipedia, Premenstrual Syndrome (PMS) (also called PMT or Premenstrual Tension) is a collection of physical and emotional symptoms related to a woman’s menstrual cycle. While most women of child-bearing age (up to 70%) report having experienced physical symptoms related to normal ovulatory function, such as bloating or breast tenderness, medical definitions of PMS are limited to a consistent pattern of emotional and physical symptoms occurring only during the luteal phase of the menstrual cycle that are of “sufficient severity to interfere with some aspects of life”. In particular, emotional symptoms must be present consistently to diagnose PMS. The specific emotional and physical symptoms attributable to PMS vary from woman to woman, but each individual woman’s pattern of symptoms is predictable, occurs consistently during the ten days prior to menses, and vanishes either shortly before or shortly after the start of menstrual flow.

Only a small percentage of women (2 to 5%) have significant premenstrual symptoms that are separate from the normal discomfort associated with menstruation in healthy women.

Culturally, the abbreviation PMS is widely understood in English-speaking countries to refer to difficulties associated with menses, whereas Premenstrual dysphoric disorder (PMMD) is a more severe condition, positioned as a psychiatric disorder similar to unipolar depression.

The History of PMS

Wikipedia notes that PMS was originally seen as an imagined disease. When women first started reporting these symptoms, they were often told it was “all in their head”. Interest in PMS began to increase after it was used as a criminal defence in Britain during the early 1980s.

The study of PMS was brought about by many characters in society. Physicians and researchers study and treat recognized medical conditions. In order to have an impact, the existence, and importance of a disease needs to be socially accepted. Women have contributed to the rise of interest in PMS and society’s acceptance of it as an illness. It is argued that women are partially responsible for the medicalization of PMS. By legitimizing this disorder, women have contributed to the social construction of PMS as an illness. It has also been suggested that the public debate over PMS and PMDD was impacted by organizations who had a stake in the outcome including feminists, the APA, physicians and scientists.

The study of PMS symptoms is not a new development. Debates about the definition and validity of this syndrome have a long history. As stated above, growing public attention was given to PMS starting in the 1980s. Up until this point, there was little research done surrounding PMS and it was not seen as a social problem. Through clinical trials and the work of feminists, viewing PMS in a social context had begun to take place.

PMS Symptoms

More than 200 different symptoms have been associated with PMS, according to Wikipedia, but the three most prominent symptoms are irritability, tension, and dysphoria (unhappiness). Common emotional and non-specific symptoms include stress, anxiety, difficulty in falling asleep (insomnia), headache, fatigue, mood swings, increased emotional sensitivity, and changes in libido.[3] Most formal definitions require the presence of emotional symptoms as the chief complaint; the presence of exclusively physical symptoms associated with the menstrual cycle, such as bloating, abdominal cramps, constipation, swelling or tenderness in the breasts, cyclic acne, and joint or muscle pain, is not considered PMS.

The exact symptoms and their intensity vary from woman to woman and even from cycle to cycle. Most women with premenstrual syndrome experience only a few of the possible symptoms, in a relatively predictable pattern. Under typical definitions, symptoms must be present at some point during the ten days immediately before the onset of menses, and must not be present for at least one week between the onset of menses and ovulation. Although the intensity of symptoms may vary somewhat, most definitions require that the woman’s unique constellation of symptoms be present in multiple, consecutive cycles.

General Emotional & Behavioural Symptoms General Physical Signs and Symptoms
  • Anger
  • Irritability
  • Aggression
  • Mood Swings
  • Tension or anxiety
  • Depressed mood
  • Crying spells
  • Mood swings and irritability or anger
  • Appetite changes and food cravings
  • Trouble falling asleep (insomnia)
  • Social withdrawal
  • Poor concentration
  • Menstrual Pain
  • Cramping
  • Lower back or small pelvis pain
  • Joint or muscle pain
  • Headache
  • Fatigue
  • Weight gain from fluid retention
  • Abdominal bloating
  • Breast tenderness
  • Acne flare-ups
  • Constipation or diarrhoea
  • Change in appetite
  • Swelling of extremities


Although the list of potential signs and symptoms is long, most women with premenstrual syndrome experience only some of these symptoms.

For some women, the physical pain and emotional stress are severe enough to affect their daily routine and activities. These signs and symptoms disappear as the menstrual period begins.

For a few women with premenstrual syndrome these symptoms are of a disabling nature every month. This form of PMS has its own psychiatric designation — premenstrual dysphoric disorder (PMDD). PMDD is a severe form of premenstrual syndrome with signs and symptoms including severe depression, feelings of hopelessness, anger, anxiety, low self-esteem, difficulty concentrating, irritability and tension. A number of women with severe PMS may have an underlying psychiatric disorder.

Types of PMS

In order to make classification of PMS easier, Dr Guy Abraham in America, devised a system of categories for the different types of PMS symptoms. These fall into four categories

Type A – Anxiety

This category which is very common in up to 80% of women each cycle, includes those symptoms such as mood swings, irritability, anxiety and tension.


•         Difficult sleeping

•         Tense feelings

•         Irritability

•         Clumsiness

•         Mood swing

Type C – Cravings 

This group includes cravings for sweets or chocolates, increased appetite, fatigue and headaches. Up to 60% of women can experience these kinds of symptoms leading up to the period.


•         Headache

•         Cravings for sweet

•         Cravings for salty food

Type H – Hyperhydration 

Type H includes symptoms such as water retention, breast tenderness and enlargement, abdominal bloating and weight gain. Up to 40% of women can experience these changes.


•         Weight gain

•         Abdominal bloating

•         Mastalgia

•         Swelling of extremities

Type D – Depression 

Depression is the largest symptom in this group but it can also include confusion, forgetfulness, clumsiness, withdrawal, lack of co-ordination, crying spells, confusion. Only 5% of women experience these symptoms but these can be the most serious if the woman is verging on the point of being suicidal.


•         Depression

•         Angry feelings no reason

•         Easily upset

•         Poor memory


•         Dysmenorrhoea

•         Change in bowel habit

•         Frequent urination

•         Hot flashes or cold sweats

•         Nausea

•         Acne


Many women will get symptoms from each Type during any one cycle. And for some women these symptoms can change from month to month, so they are not always experiencing exactly the same symptoms before each period

What causes PMS?

The exact causes of PMS are not fully understood. While PMS is linked to the luteal phase, measurements of sex hormone levels are within normal levels. In twin studies, the concordance of PMS is twice as high in monozygotic twins as in dizygotic twins, suggesting the possibility of some genetic component. Current thinking suspects that central-nervous-system neurotransmitter interactions with sex hormones are affected. It is thought to be linked to activity of serotonin (a neurotransmitter) in the brain.

Preliminary studies suggest that up to 40% of women with symptoms of PMS have a significant decline in their circulating serum levels of beta-endorphin. Beta endorphin is a naturally occurring opioid neurotransmitter which has an affinity for the same receptor that is accessed by heroin and other opiates. Some researchers have noted similarities in symptom presentation between PMS symptoms and opiate withdrawal symptoms.

Preliminary studies suggest that up to 40% of women with symptoms of PMS have a significant decline in their circulating serum levels of beta-endorphin. Beta endorphin is a naturally occurring opioid neurotransmitter which has an affinity for the same receptor that is accessed by heroin and other opiates. Some researchers have noted similarities in symptom presentation between PMS symptoms and opiate withdrawal symptoms.

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