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Hormone Information “Current research indicates that PMS is triggered by the effects of ovarian hormones on the brain, which in turn influences multiple brain-body systems and leads to a wide variety of symptoms.”
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What Is PMS?

By Elizabeth Lee Vliet, MD
Excerpted and condensed from “Screaming to be Heard,” pgs. 136 – 144, Scribner, 2003

Medical Definition of PMS (Premenstrual Symptoms)

A pattern of recurring mood, behavioral, and physical symptoms which regularly occurs between ovulation and menstruation and abates by the end of menstruation, to be followed by a symptom-free interval each month. Symptoms are present for at least six months, cause moderate to severe disruption in normal functioning, and are not due to another disorder.

  • 40 percent of all menstruating women have regular premenstrual symptoms. This figure translates into 27 million women! The majority of majority of these have a milder form of the disorder, with bloating, headache, irritability, and then “blues”
  • 5 – 10 percent of these, or 3 to 7 million women, have PMS severe enough to disrupt their personal and professional lives

PMS Symptom Clusters

  • Affective: depression, irritability, anxiety, angry outbursts, tearfulness, panicky feelings
  • Behavioral: impulsive actions, compulsions, agitation, lethargy, decreased motivation
  • Autonomic: palpitations, nausea, constipation, dizziness, sweating, tremors
  • Fluid/Electrolyte: fluid retention, bloating, weight gain, breast fullness, hands swelling
  • Dermatological: acne, oily hair, hives and rashes, herpes outbreaks, allergy outbreaks
  • Cognitive (brain): decreased concentration, memory changes, word-retrieval problems
  • Pain: migraines, tension headaches, back pain, muscle and joint aches, breast pain
  • Other: drug/alcohol abuse, food binges, hypersomnia or insomnia

What Causes PMS?

Current research indicates that PMS is triggered by the effects of ovarian hormones on the brain, which in turn influences multiple brain-body systems and leads to a wide variety of symptoms.

Many researchers believe that PMS involves a neuroendocrine imbalance. The underlying mechanism involves neuroendocrine triggers within the hypothalamus and pituitary, which in turn affect neurotransmitter function.

The diverse symptoms of PMS are caused by the many different brain centers and the whole series of neuropeptide hormones governed by these neurotransmitters. The neuropeptides beta-endorphine and MSH not only regulate the neurotransmitters involved in mood and behavior, they also modulate the release of other hormones affecting physical states and moods. The brain-body regulation of progesterone and estrogen in response to these changes in neuropeptides differs from woman to woman, which probably accounts for the various clinical forms of PMS. As better designed studies are done, I think we will find that hormone ratios and rate of change are key factors in PMS.

The clear pattern of hormone profiles in my patients is one of low estradiol and relatively normal levels of progesterone, so that there is a reduced ratio of estradiol to progesterone. I view PMS as a neuro-endocrine disorder beginning with hormone shifts that affect multiple brain centers. The brain events then trigger a variety of physical changes in multiple systems in the body, and can be aggravated by diet, substance use, and life stress.

There are other postulated causes of PMS, but I think these may also be results of neuroendocrine changes, so it is unclear whether some of these disturbances are causes of the syndrome, or are results of alterations in the reproductive hormone levels. These include:

  • Altered glucose metabolism
  • Abnormal fatty acid metabolism resulting in altered tissue sensitivity to reproductive hormones
  • Abnormalities in the regulation of fluid and electrolyte balance in the body

Other factors that may be involved in the rising incidence of PMS are:

  1. The fact that women are postponing pregnancy and having fewer pregnancies — resulting in more years of ovulatory cycles
  2. The significant increase in obesity, which alters estrogen to progesterone ratios in the body. The majority of women suffering from PMS are obese (defined as more than 20% over ideal body weight)
  3. The typical American diet, which is high in fat, protein, salt, refined sugars, alcohol, and caffeinated beverages, all of which aggravate PMS
  4. The deficit of magnesium in the diets of American women. Magnesium is an important co-factor in the synthesis of mood-elevating neurotransmitters
  5. Possible inadequate intake of B6, which is also a co-factor in the synthesis of mood-elevating neurotransmitters and is involved in the metabolism of estrogen and progesterone

Extensive, detailed information on PMS and its treatment is available in Chapter 7 of Screaming to Be Heard.

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