A PMS Symptoms and Their Timing

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An immense number of symptoms have been attributed to PMS (Table II). The most common complaints include physical symptoms (breast swelling and tenderness, abdominal bloating, headaches, muscle aches and pains, weight gain, and edema), emotional symptoms (depression, mood swings, anger, irritability, and anxiety), and others (decreased interest in usual activities, fatigue, difficulty concentrating, increased appetite and food cravings, and hypersomnia or insomnia).

Four temporal patterns have been described for PMS. Symptoms can begin during the second week of the luteal phase (about Day 21). Alternatively, they can begin at ovulation and worsen over the entire luteal phase (about Day 14). In both of these patterns, symptoms remit within a few days after the onset of menses. Some women experience a brief episode of symptoms at ovulation, which is followed by symptom-free days and a recurrence of symptoms late in the luteal phase. Women who seem to be most severely affected experience symptoms that begin at ovulation, worsen across the luteal phase, and remit only after menses ceases.

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Table II Examples of Premenstrual Symptoms

Abdominal cramps

Aches or pains

Anger

Anxiety

Bloating

Breast tenderness Clumsiness

Concentration problems Confusion

Cravings (e.g., carbohydrate, salt)

Depression

Excessive sleepiness

Fatigue

Forgetfulness

Headaches (migraine, tension)

Hot flashes

Insomnia

Impulsivity

Irritability

Moodiness

Rapid shifts in emotions Swelling (hands, feet) Weight gain

These women commonly have only 1 week a month that is symptom-free. It is unclear whether these four patterns represent distinct subtypes of PMS or whether they correspond to other conditions. These four patterns of symptoms must be differentiated from underlying illnesses that either are precipitated during the premenstrual phase or demonstrate a cyclic waxing and waning of intensity related to menstruation. They must also be differentiated from other problems associated with menses, including pelvic pain with menstruation (dysmenorrhea), infrequent menses (oligo-menorrhea), absent menses (amenorrhea), frequent menses (metrorrhagia), and excessive bleeding with menses (menorrhagia).

The course and stability of PMS over time has not been systematically characterized. It has been observed that PMS can begin any time after menarche, but women most frequently seek treatment for their symptoms in their thirties. Symptoms are believed to remit with conditions, such as pregnancy, that interrupt ovulation. Women generally report that their symptoms worsen with age until menopause, when PMS usually ceases.

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