The hormonal upset prior to menstruation results not only in aches and pains and bloatedness, but also in extreme emotional upset for perhaps as many as three-quarters of women of child-bearing age. PMS include any of the following symptoms: physical: weight gain, appetite changes, swollen hands, feet, or ankles (due to water retention), swollen, tender breasts, abdominal bloating, cramps, fatigue, nausea, vomiting, diarrhea, constipation, headache, back pain, joint or muscle pain, flare-ups of acne, cold sores, genital herpes, yeast infections, skin problems and cravings for sweets; mental and emotional: irritability, anger, mood swings, depression, crying spells, loss of confidence, difficulty concentrating, anxiety, memory loss or forgetfulness, confusion tension, irritability, depression, dizziness, violence, disturbed sleep and reduced or heightened sexual desire. All resolve with the onset of bleeding.
Since these symptoms are temporary, somewhat vague and often perceived as psychosomatic by the medical profession, the problem has gone largely unmentioned and untreated. Research has suggested that women with PMS respond abnormally to the normal ovarian hormones oestrogen and progesterone, which are released into the blood as part of the menstrual cycle. This new attribution of the cause of PMS called into question its status as an emotional disorder. Other research favors changes in neurotransmitter levels, including mood-altering endorphins and serotonin, and diet -- especially a lack of calcium. This is in line with an association with lower oestrogen levels during the last part of the menstrual cycle, oestrogen also being a precursor for serotonin. It is also possible that these imbalances are related. Until PMS is understood in medical terms, women who suffer its symptoms manage by self-experimentation or adjusting to several days of under-par health.
Most prone to PMS are women whose mothers suffered from it, women in their thirties and forties, and women who have had two or more children, or some recent disturbance to their reproductive system. Around 10% of women are disabled by PMS. Women are most likely to be admitted to prison and mental hospital before or during their period. In 1981, PMS was established in the UK law as a mitigating factor in defence of women accused of serious crimes.