What exactly is Premenstrual Syndrome? How common is it, and what triggers it? These seemingly simple questions can be surprisingly complex to answer. If you look up PMS online, sources like betterhealth and Jeanhailes describe it as a series of symptoms connected to the menstrual cycle, affecting 75% to 90% of women. Yet, another perspective sees PMS as a symptom that only significantly impacts a smaller group. This definition disparity mirrors the current state of PMS research, which can often seem confusing and contradictory. Thankfully, attitudes are changing. PMS, once stigmatised, is now being studied more objectively, and even Premenstrual Dysphoric Disorder ( PMDD ) is recognised as a legitimate gynecological condition. This shift is paving the way for more scientific exploration and funding. As understanding and acceptance of PMS grow, we’re here to shed light on what we know so far. In this post, we’ll delve into some surprising historical aspects of PMS, explore the biological theories behind it, and discuss why, despite advances, there’s still much to learn. Join us as we unravel the complexities of PMS, a subject that is as intriguing as it is relevant to many lives.

Basic Takeaways of Premenstrual Syndrome

• What’s PMS? Although there isn’t a clear definition for this condition, we can say that it is a condition that might be noticeable by physical, emotional, and behavioural symptoms. The signs appear after you ovulate and stop when your period starts.
• What is the cause of PMS? We still might not know the actual cause of PMS. But several theories explain why some women have more severe premenstrual symptoms than others. These symptoms include rapid hormonal shifts, neuro-chemical differences, and hormone sensitivity.
• Are there any risk factors for PMS? Various risk factors may be associated with this condition, including a history of depression, smoking, drinking, and genetics.
• Why do we know little about PMS? There are various reasons why research does not provide enough information about PMS. This includes society’s confusing backstory view on the condition, practical limitations to the menstrual cycle, research, historical gender bias in medical research, lack of funding from scientific bodies, and difficulties experienced when studying the complex and adequately defined topic.

What’s Premenstrual Syndrome?

Premenstrual syndrome is a multifaceted and often misunderstood condition affecting many women. Defined by a complex array of over 200 physical, emotional, and behavioural symptoms , PMS can manifest differently in every individual. These symptoms typically emerge after ovulation and subside with the onset of menstruation. The diversity of PMS symptoms is vast, ranging from physical discomforts like bloating and headaches to emotional disturbances such as mood swings and depression. Some women may primarily suffer from severe headaches, while others might grapple with water retention or gastrointestinal issues. The experience of PMS is highly individualised, and there’s no standardised “way” for women to experience it. Here’s a closer look at some common emotional and physical symptoms of PMS:

Common emotional and physical symptoms of PMS

The complexity of PMS symptoms makes it challenging to draw a clear line between what constitutes PMS and what might be considered normal variations in a woman’s cycle. While an estimated 15% of individuals with menstrual cycles report significant distress from PMS symptoms, an additional 2-6% experience severe enough symptoms to be diagnosed with Premenstrual Dysphoric Disorder ( PMDD ), a more intense form of PMS. Understanding PMS requires recognising its complicated nature and how it manifests in each individual. The broad range of symptoms and their varying intensity can make PMS a deeply personal and sometimes debilitating experience. Continued research and awareness are vital to help clarify this common condition and provide support and effective treatments for those affected.

What We Don’t Know About PMS

As said above, the description of Premenstrual syndrome is somehow complicated. Authorities in the medical field are still debating what constitutes premenstrual syndrome—they are still deciding whether the condition may determine any of the premenstrual symptoms or all the signs that affect someone individually. This question becomes even more complicated if additional branches of PMS, such as PMDD, are identified. The “why” of PMS is more precise than the “what,” which might explain why PMS researchers are still trying to comprehend it.

What Triggers Premenstrual Syndrome?

If you explore various scientific studies on premenstrual syndrome, you’ll find that researchers commonly agree on one aspect – the exact causes of this condition are not well understood. Generally, it’s recognised that PMS is linked to hormone changes, specifically the rise and fall of progesterone and estrogen levels after ovulation. Studies have shown that PMS symptoms can reappear during the postmenopausal stage when women are given cyclical progesterone, and treatments that reduce estrogen can ease PMS symptoms. A few theories are currently attempting to explain why PMS occurs. These will be described in more detail below, but it’s important to note that none completely dismisses the others. Considering the various ways each woman can experience PMS, it might be that all these theories have some truth.

Interconnected Biological Mechanisms of PMS

Premenstrual syndrome (PMS) is a complex condition caused by hormonal fluctuations, neurochemical responses, and genetic predispositions. While studies have separately identified hormonal imbalances, receptor sensitivity, neurotransmitter signalling changes, and genetic factors, current research shows these elements are closely connected.

A significant hormonal shift—marked by a sudden drop in progesterone and changes in estrogen levels—triggers a series of physiological changes. This shift not only causes physical symptoms but also affects the production of neuroactive compounds that regulate the GABAergic system, which calms neural activity. Thus, decreasing key hormones can impact mood, anxiety, and overall neurological balance.

These hormonal changes also directly affect other neurotransmitter systems. Fluctuations in serotonin levels and neuroprotective factors like brain-derived neurotrophic factor indicate that the body’s response to hormonal shifts varies. Individual sensitivity, influenced by genetics, determines how these neurochemical systems interact, resulting in diverse emotional and physical experiences during the menstrual cycle.

Understanding that these mechanisms work together offers a clearer view of PMS. The interconnectedness of hormonal changes, neurochemical effects, and genetic factors highlights the condition’s complexity. This integrated perspective encourages personalised approaches in research and treatment, ensuring future interventions align with the nuanced biological systems they target.

What are PMS Risk Factors?

Understanding the risk factors for premenstrual symptoms is complex, with various studies pointing to different factors. While some connections have been identified, the evidence is inconsistent, and more research is needed. Here are some of the most commonly cited risk factors for PMS:

Smoking

A meta-analysis of 13 studies found a moderate association between smoking and PMS, with a stronger link to Premenstrual Dysphoric Disorder (PMDD). The relationship between nicotine and PMS is complex, as it may alleviate or exacerbate symptoms.

Alcohol Consumption

Research involving 19 studies has shown that alcohol intake is linked to a moderate increase in PMS risk. The risk appears to be higher for those who consume several alcoholic drinks daily.

Depression

Individuals with a history of depression or other mood disorders are likelier to experience PMS and PMDD. While these conditions may co-occur, they are distinct from one another. Related to this is a premenstrual exacerbation , where conditions like asthma and mood disorders may worsen with the onset of menstruation.

Stress

A study on female medical students found a correlation between high-stress levels and more severe PMS symptoms. This highlights the potential role of stress management in mitigating PMS.

Genetics

Although specific genetic loci associated with PMS have not yet been identified, twin-based research indicates a strong genetic component. Family history may play a role in an individual’s susceptibility to PMS.

Diet and Lifestyle

Some studies suggest that dietary choices and overall lifestyle may also influence PMS. For example, a diet high in caffeine or salt might exacerbate symptoms, while regular exercise may alleviate them.

Age and Hormonal Factors

Age and hormonal fluctuations can also contribute to PMS. Women in their late 20s to early 40s, or those with a history of hormonal imbalances, may be more prone to PMS. In conclusion, PMS risk factors are multifaceted and may vary among individuals. The interplay between lifestyle choices, genetics, mental health, and physiological factors creates a complex picture that requires personalised approaches to understanding and managing PMS. Continued research is essential to provide more definitive insights and targeted interventions. <img alt="What is the main cause of What is the main cause of PMS?

Key Challenges in PMS Research

Despite progress in women’s health, several factors limit our understanding of premenstrual syndrome (PMS):

• Historical Underinvestment : Persistent biases have resulted in less research funding and reduced focus on women’s health compared to other medical conditions.
• Diagnostic Ambiguity : The wide range of PMS symptoms hampers the creation of consistent diagnostic criteria, complicating clinical studies and data analysis.
• Methodological Constraints : Current research methods inadequately replicate the menstrual cycle, as many lab models miss the complexities of natural hormonal changes.
• Complex Biological Interactions : Hormonal shifts, neurochemical changes, and genetic variability make it difficult for researchers to isolate the mechanisms behind PMS.

Improving research methods and securing targeted funding are crucial for advancing evidence-based understanding and treatment of PMS.

Premenstrual syndrome presents a unique challenge in the medical community due to the lack of a standardised definition . While Premenstrual Dysphoric Disorder (PMDD) has become a well-defined gynecological disorder with clear diagnostic criteria, PMS’s definition remains variable and inconsistent. Variability Across Countries and Professionals : The umbrella term “PMS” encompasses a wide range of symptoms, with over 200 identified premenstrual symptoms . This vast array of manifestations leads to differing interpretations and definitions among countries and medical professionals. How does one select a single cut-off point to diagnose PMS when the symptoms are so diverse? Impact on Research and Understanding : The absence of a standardised PMS diagnosis complicates the interpretation of research findings. Many studies categorise participants into “healthy” versus “PMS” groups, but the variability in defining PMS can lead to conflicting results. Analysing the data becomes challenging when examining everyone’s experience within these broad categories. A Potential Solution: Subcategories : One possible approach to this dilemma is to create subcategories based on various premenstrual symptoms. By grouping symptoms and studying their biological origins, researchers may gain a more nuanced understanding of PMS. This method could lead to more accurate diagnoses and targeted treatments. <img alt="What kind of symptoms are What kind of symptoms are PMS?

Conclusion

Premenstrual syndrome is a complex condition that continues to perplex both individuals experiencing it and the medical community attempting to understand it. The journey towards demystifying PMS is filled with historical biases, societal misconceptions, and scientific challenges. Yet, pursuing knowledge, empathy, and personalised care remains a beacon of hope for those affected by this complex syndrome. At Fertility2Family, we recognise the importance of understanding and compassionate support in reproductive health. Our commitment extends beyond providing quality ovulation tests and pregnancy tests . We strive to be a valuable resource for individuals on their fertility journey, offering insights, guidance, and encouragement through our fertility-related blog .

Evan kurzyp

Evan Kurzyp

Evan is the founder of Fertility2Family and is passionate about fertility education & providing affordable products to help people in their fertility journey. Evan is a qualified Registered Nurse and has expertise in guiding & managing patients through their fertility journeys.