-IBIS-1.5.0-
tx
endocrine system
premenstrual syndrome
diagnoses

definition and etiology

definition:
A constellation of symptoms characterized by nervousness, irritability, emotional instability, depression, headaches, edema, mastalgia and food cravings, which arise in the 7-14 days before menses starts.

etiology:
There are four types of PMS, each of which has distinct characteristics, and relationship to hormonal fluctuations:
• PMS-A: anxiety: mood swings, nervous tension, irritability, anxiety; related to high estrogen, low progesterone.
• PMS-C: craving: increased appetite, headache, fatigue, dizziness, fainting, palpitations; related to increased carbohydrate tolerance, decreased prostaglandin E1 in some.
• PMS-D: depression: depression, crying, forgetfulness, confusion, insomnia; related to low estrogen, high progesterone, elevated adrenal androgens if hirsute.
• PMS-H: hyperhydration: fluid retention, weight gain, swollen extremities, breast tenderness, abdominal bloating; related to excess aldosterone.
Most PMS sufferers will experience symptoms from more than one group. The most common is group A. (Abraham per Pizzorno and Murray)

signs and symptoms

generally:
• craving foods especially chocolate or sugar
• abnormal (for the patient) mood swings and hyperirritability
• edema
• bloating
• breast tenderness
• back pain
• constipation and diarrhea

specifically:
• PMS-A: anxiety: mood swings, nervous tension, irritability, anxiety
• PMS-C: craving: increased appetite, headache, fatigue, dizziness, fainting, palpitations
• PMS-D: depression: depression, crying, forgetfulness, confusion, insomnia
• PMS-H: hyperhydration: fluid retention, weight gain, swollen extremities, breast tenderness, abdominal bloating

lab findings:
• hormonal levels may be confirmatory of signs and symptoms if necessary

course and prognosis

PMS is a complex problem involving many variables, but can be well-controlled in most patients provided the appropriate diagnostic and therapeutic measures are employed.

differential diagnosis

Cyclical symptoms are normally unambiguous, but transiently:
• infections
• pregnancy
• toxic headache
• caffeine withdrawal


footnotes