The Pathophysiology of The Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) is a recurrent luteal phase condition characterized by physical, psychological, and behavioral changes of sufficient severity to result in deterioration of interpersonal relationships and normal activity. Premenstrual dysphoric disorder (PMDD) is considered a severe form of PMS.
Incorrect older theories about the causes of PMS include an estrogen excess, estrogen withdrawal, progesterone deficiency, pyridoxine (vitamin B-6) deficiency, alteration of glucose metabolism, and fluid-electrolyte imbalances. Current research provides some evidence supporting the following etiologies:

• Serotonin deficiency is postulated because patients who are most affected by PMS have differences in serotonin levels. The symptoms of PMS can respond to selective serotonin reuptake inhibitors (SSRIs), which are medications that increase the amount of circulating serotonin.
• Magnesium and calcium deficiencies are postulated as nutritional causes of PMS. Studies evaluating supplementation show improvement in physical and emotional symptoms.
• Women with PMS often have an exaggerated response to normal hormonal changes. Although their levels of estrogen and progesterone are similar to women without PMS, rapid shifts in levels of these hormones promote pronounced emotional and physical responses.
• Other theories under investigation include increased endorphins, alterations in the gamma-aminobutyric system (GABA), and hypoprolactinemia.

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