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Premenstrual Syndrome - Not All in the Mind

PMS affects many women but is not well understood. You may be one of the many women who are confused, distressed or feel alone with this problem. You may have had a hard time finding help. This leaflet won't necessarily solve your PMS problems, but it outlines a few of the more common approaches to PMS, and where to go for more information and help.

What is PMS?

The term PMS or Premenstrual Syndrome is used in this leaflet to mean both the physical and mental symptoms which occur before a period. The term PMT or Premenstrual Tension usually refers just to emotional changes.

PMS is not a straightforward issue. Women's experiences of PMS don't fit into neat categories - they are far too varied. There is no single remedy and not all women are successful in finding solutions. There is controversy within the medical profession about how to define and treat PMS. In the medical literature, there are reports of trials of many different drugs. Some of these show a benefit to some women and others show no benefit compared with a placebo (dummy pill). Different researchers get different results using the same drug, so it becomes impossible to draw conclusions. Claims are also made by vitamin companies, nutritionists and alternative practitioners. Nearly everyone offering help for PMS sufferers swears success for their cure and heaps scorn on other treatments

The reason for this confusion is that PMS is not a disease like diabetes or flu. It is a mixed bag of individual responses to an ordinary event: the menstrual cycle. The word PMS lumps together a vast collection of symptoms which have little in common besides their timing. To have a better understanding of PMS we need to look at the whole woman and see how stress, a long history of negative social attitudes towards menstruation, women's roles, jobs, relationships, nutrition and lifestyle interact with hormonal changes and other bodily processes.

The term PMS covers a range of emotional and physical symptoms experienced by women during part of the menstrual cycle the two to 14 days before a period starts. These symptoms usually clear up once the bleeding starts, but for some women they persist for a day or two into the period. There are many changes during the menstrual cycle but they are only labelled as PMS when they are distressing or disabling. Period pain is not included in the definition of PMS.

Over 150 different symptoms have been described but the most common are headache, breast swelling and tenderness, bloating, water retention, fatigue and depression, tension and irritability, and craving for sweet or salty food. Existing conditions such as depression, asthma, allergies, and epilepsy can become worse premenstrually. But the menstrual cycle isn't just a cycle of negative symptoms. The following are some of the positive symptoms experienced:

• Productivity
• High energy levels
• Sexual desire
• Intense and vivid dreaming
• Creativity

How are women affected?

The way women experience these changes varies considerably. Some women suffer intensely and feel desperate. Some aren't aware of anything other than menstruating. Some women only experience premenstrual symptoms once they stop taking the Pill or have a baby. Premenstrual symptoms can continue even after a hysterectomy. Many women find that with every cycle they experience different symptoms, or that the intensity of the symptoms varies from cycle to cycle. If you suffer from PMS you are not neurotic, a hypochondriac, or a malingerer (as some old fashioned medical text books have claimed). It is also clearly not "all in your mind".

How many women are affected?

If you are affected premenstrually, it is comforting to know you have plenty of company, although it's difficult to say how many women are affected. Investigators have come up with very different figures, depending on their definition of PMS and how they collected their information. Up to 95% of women have some premenstrual symptoms; 40% are affected by distressing symptoms, with about 5-10% experiencing severe, incapacitating symptoms.

So a small minority of women have no premenstrual symptoms at all, an equal number are incapacitated and the vast majority have symptoms ranging from mild to severe. There is not a sharp distinction between women with or without PMS.

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Based on a leaflet written by Lisa Saffron. This edition revised by Women’s Health, April 1999.

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