The Epidemiology and Social Impact of Premenstrual Symptoms

This review of premenstrual syndrome covers the definition of PMS, its prevalence, its "natural history" or age of onset, triggering factors, course over the lifespan, associated physical or emotional problems, the effects of hysterectomy and oophorectomy; its risk factors: age, parity, menstrual cycle changes, oral contraceptive use, toxemia of pregnancy; and functional impairment and treatment seeking behavior. To define PMS it is important to note that the term means negative symptoms occurring in the late luteal phase, as opposed to any cycling phenomena, or those pathologic processes that may be exacerbated premenstrually. Studies from many countries generally find that while the majority of women have premenstrual complaints, less that 10% have symptoms severe enough to be labeled PMS. Several classification schemes have been proposed to categorize PMS symptoms, pointing to possibly more than 1 entity. PMS can superimpose over other disorders, such as affective disorder, thus "secondary PMS." Pms usually begins with menarche, but more women seek treatment in their 30s. It may vary in intensity, but does not resolve spontaneously, and may fade with pregnancy, oral contraception, menopause or inhibition of ovulation. Data are conflicting on whether hysterectomy and/or oophorectomy cure PMS. Symptom distribution varies with age. Symptoms may correlate with parity. Irregular menses or heavy flow may exacerbate symptoms, and those with toxemia of pregnancy may have more severe PMS. Much research has focused on association of PMS with suicide, psychiatric hospitalization, criminal activity, work performance and accidents.