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Many women experience distinct changes in their physical and psychological functioning just prior to menstruation. During the past decade, an increasing amount of attention has been given to the symptoms of premenstrual syndrome (PMS), or what is termed "premenstrual dysphoric disorder" in the diagnostic manual of the American Psychiatric Association (APA, 1994). There is a great deal of controversy over the existence, cause, and treatment of PMS. Here we focus on the possible role of hormones in this syndrome.
Symptoms that sometimes occur just before or during menstruation in women are both physical and psychological. Physical symptoms include headaches, backaches, constipation, fluid retention, uterine cramps, and tender breasts. Psychological symptoms include feelings of irritability, stress, fatigue, depression, anxiety, low sex drive, impatience, and a general negative mood. Estimates of the number of women experiencing these symptoms vary from 10 to 80 percent. There are no differences in reported symptoms of black or white women in America (Stout, 1986). Cross–cultural research suggests cultural expectations play a major role, since in some societies these symptoms are not as often experienced (Gottlieb, 1988). Although the exact cause of PMS is not yet known, biological theories include gonadal hormone imbalance, adrenal hormone abnormality, hypoglycemia, vitamin deficiency, or endorphin neurotransmitter abnormality (Alberts & Alberts, 1990). The female gonads, the ovaries, produce estrogen and progesterone. An increase of estrogen facilitates the development of an egg cell from the ovary. Estrogen production increases during the first half of the menstrual cycle, and then tapers off prior to menstruation. Levels of progesterone increase gradually and peak during the second half of the menstrual cycle. Progesterone prepares the uterus for pregnancy. Both estrogen and progesterone levels drop off just prior to menstruation, perhaps causing PMS. Some research has found estrogen treatments reduce PMS symptoms, but other studies have not found a significant difference between subjects receiving estrogen treatments and subjects receiving a placebo. Sex hormones affect neurotransmitters, including serotonin, GABA, and the endorphins. One hypothesis is that PMS is caused by a significant decrease in beta-endorphin just prior to menstruation (Giannini, Martin, & Turner, 1990). Remember the endorphins are related to mood, which may explain the shift to a more negative, irritable mood prior to menstruation in some people. At the present time, we do not know the cause of PMS. Treatments vary widely, and include such suggestions as reducing the intake of sugar, salt, and caffeine, increasing the B vitamins, taking hormonal supplements, engaging in meditation, and exercising. Although estimates vary, most researchers think that only about 10 percent of women experience incapacitating symptoms (Gottlieb, 1988). More research is needed to understand better the cause and evaluate treatments of this condition. |
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