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Br J Psychiatry. 1990 Aug;157:249-60.

Factors related to self-reporting of the pre-menstrual syndrome.

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MRC Reproductive Biology Unit, Edinburgh.


Menstrual health questionnaires were completed by a self-selected sample of the readership of a woman's magazine (n = 5457). Sixty-one per cent of subjects described themselves as suffering from pre-menstrual syndrome (PMS) and this was largely corroborated by ratings of symptoms pre-menstrually, menstrually and post-menstrually for the most recent cycle. Mood symptoms were more strongly implicated than physical ones. Self-report of PMS was found to be modestly associated with aspects of parity and oral contraceptive use, but strongly and positively related to the duration of 'natural' menstrual cycles (i.e. uninterrupted by pregnancy or steroidal contraception) and to psychosocial stress. There were interactions among psychosocial factors and between psychosocial load and duration of natural cycles.


Studies of premenstrual syndrome (PMS) have identified so many systems and associated factors that it is difficult to assess whether PMS is a discrete entity or encompasses a variety of cyclical phenomenon with differing etiologies. A heuristic, retrospective study of PMS was conducted among 5457 readers of a UK women's magazine who mailed in a menstrual health questionnaire that focused on the most recent menstrual period. 61% of respondents indicated that they were currently suffering from PMS, 32% were uncertain, and 7% did not experience PMS. Mood symptoms, reported by 65%, included irritability (65%), anger for no apparent reason (64%), and easily upset (60%). Of the physical symptoms, the most prevalent were abdominal bloating (45%) and breast tenderness (40%). There was a remission of mood and physical disturbances postmenstrually in 79% and 94% of sufferers, respectively. Oral contraceptive (OC) users were significantly less likely to report PMS than nonusers, especially nulliparous users. In addition, there was a generally trend for PMS to increase in prevalence with increasing age. More significant was the finding that, the longer a woman has been experiencing menstrual cycles uninterrupted by pregnancy or unmodified by OC use, the more likely she is to self-report PMS. After 6 years of natural cycles, there was a higher prevalence of PMS among women with a high psychosocial stress level. In women with no psychosocial "load," PMS is most prevalent in nulliparous women and after 2 years of natural cycles. These findings suggest that PMS may persist as a result of biological sensitivity to premenstrual changes, possibly interacting with psychosocial factors. Further research will focus on measures of the severity of PMS clinical symptoms and patterns of symptom change.

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