HEALTH; Personal Health
By Jane E. Brody
Published: January 5, 1989
Premenstrual syndrome, now widely known, discussed, diagnosed and even used as a legal defense, is still a biomedical mystery whose cause and proper treatment have yet to be established.
What is clear is that most women experience premenstrual physical or emotional changes to some degree and that these changes are biologically based and entirely normal. But only a small proportion of women are affected severely enough that it disrupts their lives. It is these severe cases that have given rise to medical and social concern about PMS.
It is also clear that most notions about the origins of premenstrual symptoms and many prescribed therapies have not been supported by well-designed studies. Many symptoms that may have different causes have often been lumped together under the label PMS. Theories to explain the symptoms abound, but none explains them. For example, although scientists believe the symptoms are caused by hormonal changes, they have been unable to document any differences in quantity and types of hormones between women with severe PMS and those with few or no symptoms.
But even without a full scientific understanding, researchers specializing in PMS report that several popular self-help measures enable many women to reduce or eliminate disturbing symptoms that they experience in the days before menstruation.
Surveys indicate that about three-fourths of women experience some physical or emotional changes premenstrually; most have mild to moderate symptoms, no different in type or intensity from the changes in body or mood that from time to time can affect anyone, man or woman.
But about 10 percent of menstruating women say they experience severe disturbances that impair them socially and occupationally and interfere with their ability to carry out normal activities. Others have underlying physical or mental disorders that become noticeably worse in the days before menses.
In fact, recent studies conducted at the New York State Psychiatric Institute strongly indicate that there is not one ''disorder'' but that premenstual changes occur in different patterns, each of which may have a distinct biochemical origin. Some women suffer primarily physical symptoms and others experience mainly emotional disturbances of varying types. And even within the same woman the symptoms and severity of the syndrome may vary from cycle to cycle. What Is PMS? Although in popular accounts PMS is usually associated with serious emotional disturbance, most researchers use the term to refer to a varied group of emotional and physical changes that repeatedly occur in relation to a woman's menstrual cycle. The most prominent symptoms occur in the days before and perhaps one or two days after the start of menstrual bleeding.
Common physical complaints include bloating, weight gain, painfully swollen breasts, abdominal discomfort, lack of energy, headache and worsening of chronic illnesses like asthma, allergies, epilepsy or migraine. Typical emotional symptoms may include depression or negative mood, irritability, anxiety, changes in body image and feelings of being unable to cope or having lost control.
''There is nothing distinctive about the mood and behavior changes in women and men,'' Dr. Jean Endicott said. ''The only difference is that in women these changes are cyclical.'' Dr. Endicott, a professor of clinical psychology at the New York State Psychiatric Institute, which is at the Columbia University College of Physicians and Surgeons, also noted that the syndrome is not unique to American women; it has been cited in one form or another in other countries.
Dr. Endicott and her colleagues are among a handful of researchers who have charted the signs and symptoms of PMS in large numbers of women. By having each of the women keep a detailed daily diary of relevant symptoms and life circumstances along with a record of her menstrual cycle, they have shown these things:
* About one-quarter of women have no premenstrual problems or only minimal ones.
* About one-third report mild to moderate changes that are noticeable to them and perhaps to the immediate family but that do not disrupt normal activities.
* Another third experience premenstrual worsening of a chronic underlying health problem not directly related to the menstrual cycle. Because of the premenstrual effects, the chronic problem can temporarily disrupt normal activities.
* Less than one-tenth have relatively severe symptoms that could impair their ability to interact normally with other people and interfere with job performance and normal activities. Such women face a greater-than-average risk of losing jobs, friends and spouses because they may say and do things during PMS that they would not ordinarily say or do.
Dr. Endicott said that, unfortunately, most researchers and clinicians studying the syndrome fail to distinguish between the various patterns of symptoms and thus end up with spurious or inconsistent findings. She said a proper diagnosis and description of the syndrome in each woman under study was the first critical step.