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What is Premenstrual syndrome?

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.

What causes premenstrual syndrome?
What causes premenstrual syndrome?

Basic Takeaways of Premenstrual Syndrome

  • What’s PMS? There isn’t a clear definition for this condition. So we can say that PMS is a condition that might be noticeable by physical, emotional, and behavioural symptoms. The signs appear after you ovulate and stop when the 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 associate 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 give enough research about PMS. This includes how society has a confusing backstory view on the condition. Practical limitations to the menstrual cycle, research, historical gender bias in medical research, no 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

Emotional Symptoms: Physical Symptoms:
Irritability: A heightened sense of frustration or impatience. Weight Gain: Temporary increase in body weight.
Mood Swings: Rapid changes in emotional state, from happiness to sadness. Bloating: Swelling or puffiness in the abdominal area.
Crying Spells: Unexplained bouts of crying or feeling tearful. Headaches: Persistent or recurring headaches.
Depression: Hopelessness, sadness, or a lack of interest in daily activities. Tender Breasts: Sensitivity or pain in the breasts.
Anxiety: Increased nervousness or worry. Swelling of the Feet or Hands: Noticeable swelling in extremities.
Libido Changes: Fluctuations in sexual desire. Food Cravings: Intense desire for specific foods, often sugary or salty.
Concentration Difficulties: Trouble focusing or completing tasks. Body Aches and Pain: General discomfort or pain in muscles and joints.
Confusion: A sense of disorientation or difficulty in understanding. Gastrointestinal Upsets: Issues such as diarrhea or constipation.
Sleep Pattern Disruption: Changes in sleep habits, such as insomnia or oversleeping. Skin Problems: Changes in skin condition, such as acne or dryness.

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 is PMS or premenstrual syndrome?
What is premenstrual syndrome?

What We Don’t Know About PMS

As said above, Premenstrual syndrome description is somehow complicated. Authorities in the medical field are still debating on 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” and might be why PMS researchers are still trying to comprehend.

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.

Currently, a few theories are 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.

Five theories on the main cause of premenstrual syndrome?

Hormonal Differences: Theory 1

The relationship between hormone levels and PMS symptoms has been a subject of scientific inquiry. A theory once posited that pronounced PMS symptoms in women might be linked to low progesterone and high estrogen levels in the days preceding menstruation. However, evidence supporting this claim has been mixed, and some researchers have even contested it. Ongoing studies continue to explore this complex relationship.

An intriguing aspect of this theory is the possibility that individuals with menstrual cycles may have similar progesterone and estrogen levels during different phases. Yet, those who suffer from PMS might undergo a more abrupt or significant drop in these hormones.

A study that lends some insight into this theory was conducted on 46 Brazilian women. Progesterone levels were measured three times daily, revealing a gradual decline in those without PMS in the eight days leading up to menstruation. Conversely, those with PMS experienced a sharp decrease in these hormones over the last three days before their periods. The limited size of this study means that the evidence is not robust, but it opens the door for further exploration into the hormonal dynamics associated with PMS.

Hormone Sensitivity: Theory 2

The concept of hormone sensitivity has emerged as a prevalent theory in the Premenstrual Syndrome study. This theory posits that specific individuals may have an innate predisposition to react intensely to the normal hormonal changes that occur throughout the menstrual cycle.

Recent research has shed light on this theory through neuroimaging studies. These studies have revealed that in patients with Premenstrual Dysphoric Disorder (PMDD), there is an increase in brain metabolism, where the brain utilises glucose for energy, and alterations in neural transmitter activity, which governs the chemical messaging within nerve cells. Furthermore, these studies have identified unexpected variations in brain activity during the luteal phase, with certain areas of the brain showing both decreased and increased responsiveness to fluctuating hormone signals.

In a targeted experiment, researchers sought to further explore this theory by suppressing women’s ovaries, both with and without PMS. Following the administration of a controlled dose of progesterone and estrogen, only those women who typically experienced PMS manifested premenstrual symptoms. This finding underscores the theory that hormone sensitivity, rather than hormone levels, may be a key factor in developing PMS symptoms.

This theory of hormone sensitivity opens new avenues for understanding and treating PMS, emphasising the individual’s unique response to hormones rather than a generalised hormonal imbalance. It also highlights the complexity of PMS and the need for ongoing research to comprehend the underlying mechanisms that contribute to this condition fully.

premenstrual syndrome
Premenstrual syndrome (PMS) – Symptoms and causes

GABA and ALLO Connection: Theory 3

The connection between GABA (gamma-aminobutyric acid) and ALLO (allopregnanolone) has recently emerged as a significant theory in understanding specific PMS symptoms. This theory explores the relationship between these two substances and how they interact within the nervous system.

  • The Progesterone-ALLO Connection: Progesterone is metabolised into ALLO, enhancing GABA receptors’ efficiency and calming the nervous system. As progesterone levels decrease towards the end of the menstrual cycle, ALLO levels also decline. This reduction may lead to less effective GABA signalling, causing the nervous system to be less relaxed than usual.
  • Individual Variations in ALLO Production: Some women may not convert progesterone into ALLO as efficiently, leading to variations in how PMS symptoms manifest.
  • ALLO Levels and PMS Symptoms: Evidence indicates that PMS symptoms are less pronounced when ALLO levels are low and more pronounced when there are fluctuations due to changing progesterone levels.
  • SSRIs and ALLO-Progesterone Link: Selective serotonin reuptake inhibitors (SSRIs) are known to be effective treatments for PMS symptoms. This effectiveness may be attributed to SSRIs’ ability to increase the conversion of progesterone to ALLO, thereby enhancing GABA signalling.
  • GABA Signaling and Reproductive Health: This theory also extends to other areas of reproductive health. For example, GABA signalling has been found to impact women suffering from postpartum depression.

This theory offers a nuanced understanding of the biochemical processes underlying Premenstrual syndrome symptoms. Focusing on the interaction between GABA and ALLO and how progesterone levels influence them provides a more targeted approach to understanding and potentially treating PMS. It also opens up new avenues for research into related conditions, such as postpartum depression, further emphasising the complexity and multifaceted nature of women’s reproductive health.

Serotonin Dysregulation: Theory 4

The role of serotonin in premenstrual symptoms has become a focal point of research, particularly since selective serotonin reuptake inhibitors (SSRIs) are a primary treatment for PMS. This theory explores the complex relationship between serotonin and PMS, shedding light on potential underlying mechanisms:

  • SSRIs and PMS Treatment: The effectiveness of SSRIs in treating PMS has led researchers to investigate the connection between serotonin and premenstrual symptoms. This connection has become a critical study area, offering insights into potential treatment pathways.
  • Neuroimaging Studies: Recent neuroimaging studies have observed altered serotonin activity in the brains of PMDD (Premenstrual Dysphoric Disorder) patients. These findings suggest that serotonin dysregulation may play a role in the manifestation of premenstrual symptoms.
  • Low Serotonin Levels and Mood: Some smaller studies have revealed a potential link between low serotonin levels and poor premenstrual mood in otherwise healthy women. This connection further emphasises the importance of serotonin in understanding PMS.
  • Part of a Bigger Picture: It’s essential to recognise that serotonin dysregulation may not be the sole explanation for premenstrual symptoms. Instead, it may be one piece of a more complex puzzle, possibly interacting with factors such as GABA.

This theory underscores the complicated nature of PMS and PMDD and the potential interplay between neurotransmitters. By focusing on serotonin’s role, researchers uncover new dimensions of understanding, not only about PMS but also about broader aspects of women’s mental and emotional health. The exploration of serotonin dysregulation offers a promising avenue for future research and treatment, contributing to a more comprehensive and nuanced understanding of premenstrual symptoms.

9 DPO Symptoms
What are the 3 symptoms of premenstrual syndrome?

Levels of Brain-Derived Neurotrophic Factor (BDNF): Theory 5

Brain-Derived Neurotrophic Factor, or BDNF, is a protein that has recently come to the forefront of scientific research for its role in neuronal protection, growth, and the formation of new connections. Its association with premenstrual symptoms has been explored in various ways:

  • BDNF Levels and PMS: A small-scale study found that BDNF levels in PMS patients dropped significantly during the luteal phase of the menstrual cycle, while those without PMS experienced an increase. This fluctuation in BDNF levels may provide insights into the underlying mechanisms of PMS.
  • Genetic Component: The link between Val66Met (a genetic polymorphism of BDNF associated with mood disorders) and PMS suggests a genetic component to premenstrual symptoms. Understanding this connection could lead to more targeted interventions.
  • Relevance to Pregnancy: The relationship between BDNF and PMS is also significant for expectant parents, as low BDNF levels have been associated with depression during pregnancy and postpartum.

The exploration of BDNF in the context of PMS indicates the multifaceted nature of premenstrual symptoms. With PMS manifesting in diverse ways across individuals, various biological factors likely contribute to how the body expresses these symptoms.

The ongoing investigation into the biological underpinnings of PMS, including the role of BDNF, holds promise for more personalised treatments and improved outcomes. By delving into the complexities of BDNF and its relationship with PMS, researchers are paving the way for a deeper understanding of this common condition and developing more effective therapeutic strategies.

What is premenstrual syndrome explained?
How is premenstrual syndrome explained?

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 are not yet identified, twin-based research indicates a strong genetic component to PMS. 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.

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What is the main cause of PMS?

Four reasons why PMS is Under-Researched Compared to Other Health Topics

Failing to prioritise women’s health

The disparity in research between premenstrual syndrome and other medical conditions, such as erectile dysfunction (ED), is notable. A recent observation highlighted that there are five times more research articles on ED than on PMS. This discrepancy prompts an examination of why PMS remains under-researched and under-prioritised. Here are some potential reasons:

Historical Bias Towards Women’s Health: Women’s health has been historically overshadowed, with societal biases and misconceptions playing a significant role. Fear, condemnation, and misunderstandings related to women’s bodies, sexuality, and menstruation have contributed to a lack of focus on these areas. Even today, these biases persist, leading to a healthcare system that may not take women’s complaints about pain or other medical issues as seriously as it should.

Lack of Priority in the Medical Community: The relationship between women’s health and the menstrual cycle has not been a priority within the medical community. While ancient medical practitioners like Hippocrates attempted to explain PMS symptoms, the Western medical community did not significantly update these theories until the 20th century.

Evolution of Understanding PMS: Initially referred to as premenstrual tension, understanding this condition evolved. By the 1950s, premenstrual syndrome was renamed to encompass the broad range of symptoms now associated with PMS. Despite this evolution, the medical community’s neglect of PMS has hindered research progress.

Prevalence vs. Research Focus: Even though PMS has been recognised as a common condition affecting an estimated 40% of individuals with menstrual cycles, its complex history has disadvantaged medical research. The prevalence of PMS in the past and present has not translated into a corresponding focus on understanding and treating this condition.

PMS as a Societal Concern: A Mid-20th Century View

During the mid-1900s, the medical community’s focus on premenstrual syndrome was largely driven by its perceived impact on society. Many flawed or misguided studies linked PMS to various societal issues, ranging from violent crimes to aeroplane accidents.

Lunar Connections and Misunderstandings: A doctor coined the term “PMS” itself, which drew parallels between women’s lunar cycles and the word “lunatic.” In a 1954 paper, he implied that premenstrual syndrome was often associated with this term, reflecting a lack of understanding of the condition.

Societal Mistrust and Stereotypes: In subsequent decades, PMS became a symbol of societal mistrust towards those with menstrual cycles. It was seen as limiting biological females’ rationality, leading to stereotypes and misconceptions.

Legal Use of PMS: The 1980s saw PMS as a legal defence in the United Kingdom, with women avoiding prison sentences for serious crimes like murder. These cases brought PMS into public discourse, igniting debates about menstrual cycles’ influence on self-control and behaviour.

Neglect of Medical Understanding: Despite widespread attention, the medical community did not prioritise treating or understanding PMS. The societal interpretations and controversies overshadowed the need for scientific research, hindering progress in addressing the condition’s underlying causes and symptoms.

The portrayal of PMS as a societal problem rather than a medical condition has shaped perceptions and attitudes towards the syndrome. The historical view of PMS reveals a complex relationship between societal beliefs, legal considerations, and medical neglect without a clear path towards recognising it as a legitimate medical concern that warrants proper attention and care.

PMS Symptoms Vs. Pregnancy Symptoms
PMS Symptoms Vs. Pregnancy Symptoms

Flaws in PMS Research Models

The research into women’s menstrual health faces unique challenges, primarily due to the distinctiveness of the human menstrual cycle. Unlike many other health topics, the lack of suitable animal models has hindered the progress of basic scientific research on premenstrual syndrome (PMS).

Use of Non-Menstruating Animals: Standard lab rats, which do not menstruate but have estrous cycles, have been used in attempts to simulate PMS. Researchers have administered daily progesterone treatments to female rats, leading to a withdrawal period resembling the final week of a woman’s menstrual cycle when progesterone levels drop. This induced state in rats often manifests signs of depression, providing insights into the potential role of serotonin and other brain chemicals in PMS symptoms.

Limitations of the Progesterone Model: However, this PMS model’s reliance on a rapid decrease in progesterone levels raises questions about its applicability to humans. The artificial nature of the progesterone withdrawal and the differences between estrous cycles and human menstruation limit the model’s relevance and may lead to misleading conclusions.

A New Potential Model: The African Spiny Mouse: A recent discovery of a menstruating rodent, the African spiny mouse, offers a promising avenue for PMS research. Observations of this mouse’s behaviour and eating patterns before menstruation suggest a natural model for PMS. The coming years may reveal whether this spiny mouse can become a new standard for PMS research, providing a more accurate representation of the human condition.

There isn’t a universal PMS definition.

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 the creation of 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.

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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.

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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.

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