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Premenstrual Stress Is Three Syndromes

It's premenstrual "something" that we're talking about here. The idea that some women had certain physical and emotional symptoms before their menstrual flow goes back at least to the time of Hippocrates (about 400 B.C.). He described a set of symptoms that could be severe--including thoughts of suicide--in some women. These aggregated symptoms were called "premenstrual tension syndrome" by the 1930s and became known as premenstrual syndrome (PMS) in the 1950s.

Although nearly 90 percent of women experience premenstrual symptoms, most report relatively mild symptoms, with only 5 to 10 percent reporting severe symptoms. Researchers have had difficulty studying this topic because the condition has never been clearly defined.

But three definable syndromes have now been characterized--premenstrual dysphoric disorder (PMDD), PMS and premenstrual magnification. Each occurs after the middle of women's menstrual cycles, when the egg (ovum) is characteristically produced. This is called the luteal phase. A woman experiencing symptoms in this pattern should fill out a calendar monthly for at least two months to determine with her physician whether she might have one of these syndromes. If so, the good news is that treatment is available.

PMDD is the most severe. It has a strong mental health component, with symptoms of irritability, anger, internal tension, sadness and mood swings. To make the diagnosis, at least one of these symptoms must be present. In all, five or more symptoms must be present, out of a total of 11. For women with PMDD, the symptoms are severe enough to interfere with daily life.

The definition of PMS, on the other hand, is very broad. Only one symptom need be present (although menstrual cramps is not one of these) out of a list of more than 100; many of these symptoms are physical rather than emotional, such as bloating, headaches or change in appetite.

The last category is premenstrual magnification (also called premenstrual exacerbation), in which symptoms of an underlying major psychiatric disorder or medical condition are even worse during the luteal phase.

Treatment of PMS depends on the specific symptom, while treatment for premenstrual exacerbation depends on the underlying problem. PMDD responds to many of the drugs that were developed to treat depression, particularly the SSRIs (selective serotonin reuptake inhibitors). The most studied of these is fluoxetine.

Does that mean PMDD is no different from any other kind of depression? It's unique in that not only does PMDD respond to treatment almost immediately upon taking the drug (unlike major depression), but often very small doses, used only during the luteal phase, are required. This is good news for PMDD sufferers who do not want to take medication continuously.

Last Reviewed 2005

Source: Cynda Johnson, M.D.
University of Iowa Department of Family Medicine

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.