Symptoms:

Nearly every woman at some point has some symptoms as menstruation approaches. For about half of these women, symptoms are mild and do not affect normal daily life. The other half report symptoms severe enough to impair daily life and relationships. Between 3 - 5% of women report extremely severe symptoms.

In general, premenstrual syndrome (PMS) is a set of physical, emotional, and behavioral symptoms that occur during the last week of the luteal phase (1 - 2 weeks before menstruation) in most cycles. The symptoms typically go away within 4 days after bleeding starts and do not start again until at least day 13 in the cycle. Women may begin to experience premenstrual syndrome symptoms at any time during their reproductive years. Once established, the symptoms tend to remain fairly constant until menopause, although they can vary from cycle to cycle.

Physical Symptoms

• Breast engorgement and tenderness
• Abdominal bloating
• Constipation or diarrhea
• Headache and migraine (migraine may increase severity of PMS symptoms)
• Swelling of the hands or feet
• Weight gain
• Clumsiness
• Nausea and vomiting
• Muscle and joint aches or pains

Emotional and Behavioral Symptoms

• Depression (severe depression before menstruation, called premenstrual dysphoric disorder, occurs in about 5% of women with PMS)
• Anxiety and panic attacks
• Insomnia
• Change in sexual interest and desire (although some women lose interest, others have a heightened drive)
• Irritability
• Hostility and outbursts of anger (in severe cases, violence toward self and others)
• Increased appetite often with specific food cravings (especially salt and sugar)
• Mood swings (although angry outburst or negative emotions are common, some women experience very positive bursts of creative energy before a period)
• Inability to concentrate and some memory loss (although women often report these symptoms, studies have indicate no actual differences in mental and thinking tasks between women with PMS or premenstrual dysphoric disorder and women without these syndromes)
• Withdrawal from other people
• Confusion
• Being accident prone
• Lethargy and fatigue

Premenstrual Dysphoric Disorder

The American Psychiatric Association has specific criteria that defines premenstrual dysphoric disorder (PMDD). PMDD, also called late-luteal dysphoric disorder, is a condition marked by severe depression, irritability, and tension before menstruation. PMDD has features of both anxiety and depression disorders.

Diagnostic Criteria. Symptoms must occur during the last week of the premenstrual (luteal) phase in most menstrual cycles. They should resolve within a few days after the period starts. They should markedly interfere with work or social functioning. Also, symptoms should not just be those of another underlying disorder.

Five or more of the following symptoms must occur:

• Feelings of sadness or hopelessness, possible suicidal thoughts
• Feelings of tension ,anxiety, or edginess
• Sudden mood swings marked by feeling suddenly tearful or feeling increased sensitivity to rejection
• Persistent irritability or anger that causes conflict with other people
• Disinterest in daily activities and relationships
• Trouble concentrating
• Fatigue or low energy
• Food cravings or bingeing
• Sleep disturbances
• Feeling overwhelmed or out of control
• Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain