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Shivering, lassitude and heaviness of the head denotes the onset of menstruation … mistiness of vision is relieved by menstruation.


Premenstrual syndrome (PMS) is defined as a disorder of non-specific somatic, psychological or behavioural symptoms occurring during the late luteal phase of the menstrual cycle.1

The pathogenesis of PMS is still uncertain. Among the proposed causes are pyridoxine deficiency, excess prostaglandin production, hypoglycaemia and neurotransmitter (in particular, GABA) abnormalities. However, PMS is most probably related to enhanced sensitivity to progestogen with an underlying serotonin deficiency.2

Key facts and checkpoints

  • PMS increases in incidence after 30 years, with a peak incidence in the 30–40 years age group.

  • PMS also occurs in the 45–50 years age group, when it may alternate with menopausal symptoms, causing clinical confusion.3

  • The symptoms of PMS decrease in severity just before and during menstruation.

  • The symptoms cannot be explained by the presence of various psychological or psychiatric disorders.

  • The severe form of PMS is classified in the Diagnostic and Statistical Manual of Mental Disorders (4th and 5th edns) as premenstrual dysphoric disorder (PMDD).


Up to 90% of women may experience premenstrual symptoms, which can vary from moderately severe in 20–40% of women to disabling in 2–9%.4 And perhaps 2–5% of women experience symptoms so debilitating as to significantly reduce their quality of life. In this case, they are considered to have premenstrual dysphoric disorder (PMDD).1


Various symptoms from among the 150 reported are summarised in FIGURE 104.1.

FIGURE 104.1

Symptoms of premenstrual syndrome

Symptoms usually reach a peak during the last 5 premenstrual days and remit within a few days of menstruation. Typically, they recur in subsequent cycles, although variation between cycles is common. The most common psychological symptoms are depression and irritability, while headache, bloating and breast tenderness are the most common physical symptoms.

Classification of PMS

It is convenient to classify PMS in terms of severity of symptoms.3

  1. Mild: symptoms signal onset of menstruation. No medical advice sought or needed.

  2. Moderate: symptoms annoying but insufficient to interfere with function at home or work. Medical advice sought in about one-third.

  3. Severe: symptoms are such that functions at work or home are disrupted. Medical advice is usually sought. This disruptive form is labelled PMDD (see TABLE 104.1).

Table 104.1Summary of PMDD criteria*5

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