If you read any book or article about PMS, you will notice that it is invariably accompanied by a long list of symptoms. In our opinion, creating such a list is futile and could even be counterproductive, because the syndrome is so variable. Some of the symptoms can occur in relation to your monthly cycle, and many of the symptoms can— once having occurred—also change during your cycle. The same symptom can affect other women in very different ways. There is no group of symptoms that uniformly and regularly affects each individual woman.
If you think you might have PMS, the best way to determine how the syndrome affects you is to chart any changes in perception, behavior, and feeling that you experience during your monthly cycle using the format described earlier for Claire. Physical symptoms could include breast tenderness and swelling, abdominal bloating, edema, and weight gain. Emotional symptoms often include anxiety, depression, tension, insomnia, anger, and fear. Behavioral changes sometimes have included absenteeism from work, proneness to accidents, and in very rare instances, other phenomena such as criminal tendencies and suicidal impulses.
The variety of symptoms of PMS can make diagnosis difficult. The best way to begin involves giving your physician a very detailed history. You will also probably be asked to chart your symptoms carefully, measure your body weight on a daily basis, and record your entire behavioral pattern over two to three monthly menstrual cycles. Your doctor, then, has a basis for evaluation. (A PMS diagnostic chart has been included to help you chart your symptoms. Take the chart to your physician.)
Since many theories relate PMS to hormonal changes, you may wonder why physicians do not simply measure the amount of estrogen and progesterone in your blood. Unfortunately, this practice does not offer the easy answer it seems to suggest. Your hormonal changes may be so subtle that your hormone measurements fall within accepted normal limits even though your body is reacting strongly to those changes. So these blood tests will merely be expensive for you and will not help to diagnose your problem.
Studies of hormonal levels in premenstrual syndrome have shown a striking lack of consistency. For example, comparisons of hormone levels in both women with and without PMS have failed to show any statistical differences between the two groups. This lack of difference shows that PMS is not caused by abnormal circulating levels of gonadotropins or gonadal hormones.
Other hormones such as prolactin, Cortisol, and thyroid hormone have been thought to be possible causes of PMS. However, no substantiated medical reports exist as yet to confirm this theory. Other investigators have tried to relate symptoms such as irritability, aggression, and paranoia to higher levels of male hormone within the female body. Studies have also failed to confirm this relationship.
Since it seems that we cannot blame PMS on hormone imbalances, we are led to theorize that PMS may be the result of abnormal responses to normal endocrine levels. Research today is directed toward more sophisticated evaluations to learn what actually occurs chemically in the brain.
When large groups of women with premenstrual symptoms were studied, the results suggested that PMS actually may be clusters of problems that can occur separately at different phases in a woman’s life. One of these phases is the premenopausal time. It is likely that women who have few PMS symptoms in their early reproductive years, but who suddenly develop such symptoms in their later reproductive years, may be suffering from a variant of PMS that should appropriately be called premenopausal syndrome.