Risk Factors

Premenstrual syndrome (PMS) is reported in women in many cultures worldwide. About 80% of women in their reproductive years experience some emotional and physical symptoms before their periods that impair daily activities. An estimated 30% of women feel they need treatment for symptoms. Between 3 - 8% of women report very severe symptoms, notably premenstrual dysphoric disorder (PMDD). A number of factors may put a woman at higher risk for PMS.

Age

The risk for severe PMS is higher in younger women and onset usually begins around the mid-twenties. (In one survey of adolescents, however, 88% reported moderate to severe premenstrual symptoms.) Women typically first seek treatment when they are in their 30s.

Although some evidence has suggested that PMS symptoms diminish after age 35, a 2002 study reported that 6.4% of women between ages 36 and 44 had a diagnosis of premenstrual dysphoric disorder. Naturally, PMS and any manifestation of it end at menopause.

Psychologic Factors

Psychologic factors often play an important role in a woman's risk for PMS and premenstrual dysphoric disorder (PMDD). Studies indicate that strong psychologic support can significantly reduce some PMS symptoms.

Depression. One large study of women ages 36 - 44, reported that 25% had symptoms indicative of major depression. Such women were significantly more likely to have PMS than those who were not depressed. PMDD can occur without any history or presence of major depression. Nevertheless, major depression is very common with PMDD.

Studies have specifically found a high prevalence of PMDD in women who also suffer from seasonal affective disorder (SAD). This form of depression is characterized by annual episodes of depression during fall or winter that remit in the spring or summer when daylight hours increase. Some studies suggest that women with both PMDD and SAD may share genetic factors that make them vulnerable to these forms of depression.

Personality Factors Some studies suggest an increased incidence of low self-esteem in women who report severe premenstrual symptoms.

Cultural Factors

Studies indicate that cultural factors affect the perception and severity of PMS symptoms. For example, a study of Chinese women reported that pain was the most significant PMS symptom, while depression predominated in Western women. A 2002 study reported that Asian American women reported fewer PMS symptoms than their Caucasian counterparts, while Hispanic American women reported more severe symptoms. Other studies have reported little difference between American and Northern European experiences of premenstrual symptoms and impact on daily life.

Other Factors Associated with PMS

Studies have found some factors associated with a higher risk for PMS or more severe symptoms, although there is no clear evidence that any of the following are actual risk factors:

  • Having a mother who had PMS
  • Being sedentary
  • Stress
  • High-sugar diet
  • Consumption of large amounts of caffeine
  • Alcohol abuse
  • Women with more children may experience more severe symptoms than those with fewer children