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Sanchez, B.N.; Kraemer, W.J.; Maresh, C.M. Defining Premenstrual Syndrome. Encyclopedia. Available online: (accessed on 19 June 2024).
Sanchez BN, Kraemer WJ, Maresh CM. Defining Premenstrual Syndrome. Encyclopedia. Available at: Accessed June 19, 2024.
Sanchez, Barbara N., William J. Kraemer, Carl M. Maresh. "Defining Premenstrual Syndrome" Encyclopedia, (accessed June 19, 2024).
Sanchez, B.N., Kraemer, W.J., & Maresh, C.M. (2023, July 04). Defining Premenstrual Syndrome. In Encyclopedia.
Sanchez, Barbara N., et al. "Defining Premenstrual Syndrome." Encyclopedia. Web. 04 July, 2023.
Defining Premenstrual Syndrome

Premenstrual Syndrome (PMS) is a complex physiological and psychological condition that affects a significant number of women during their reproductive years. Although the exact etiology of PMS remains unclear, its symptoms, including mood swings, bloating, irritability, and fatigue, can significantly impair the quality of life for affected individuals. The management of PMS traditionally involves pharmacological interventions; however, emerging evidence suggests that exercise may offer a valuable non-pharmacological approach to alleviate PMS symptoms. 

premenstrual syndrome women’s health exercise

1. Introduction

Premenstrual syndrome (PMS) is characterized by a collection of physical, emotional, psychological, and behavioral symptoms that appear in a cyclic and recurring pattern during the late luteal phase of the menstrual cycle and alleviate within two to four days of menstruation. These symptoms negatively influence personal and professional aspects of life including work performance, social activities, and inter/intrapersonal relationships. The extent to which PMS impacts the lives of women is underrecognized and is oftentimes dismissed as a natural part of being a woman.

2. Defining PMS

The American College of Obstetricians and Gynecologists (ACOG) defines PMS as a condition where a woman experiences at least one affective symptom and one somatic symptom that causes dysfunction in social, academic, and/or work performance [1]. These symptoms must occur outside of the context of other conditions such as thyroid disorders and other mental health illnesses, and in the absence of any pharmacologic therapy, hormone ingestion, or drug use [1].
There is a more severe, psychological premenstrual condition called Premenstrual Dysphoric Disorder (PMDD) which the American Psychiatric Association (APA) defines as the presence of debilitating somatic and behavioral symptoms, which could include a major depressive episode, that significantly affects the quality of life or prevents a woman from functioning on an everyday basis [2]. Using the DSM-5, the presence of at least five of the listed symptoms must be present for a PMDD diagnosis [2]. Some of these symptoms include depressed mood, anxiety, affective lability, loss of interest, lethargy, a marked change in appetite, hypersomnia or insomnia, and other physical and emotional symptoms.
The International Society for Premenstrual Disorders (ISPD) published a consensus article with a thorough classification of PMS by distinguishing premenstrual disorders (PMD) into two categories [3]. The symptom characteristics of the core PMD category can be somatic and/or psychological, occurring in ovulatory menstrual cycles during the luteal phase, and are prospectively rated for at least two menstrual cycles. These symptoms could cause significant impairment of work, school, social activities, hobbies, and interpersonal relationships [3]. The other category is described as variant PMD which includes premenstrual exacerbation where symptoms of a separate and underlying psychological or somatic disorder are significantly worsened premenstrual; PMD due to non-ovulatory ovarian activity where symptoms arise from continued ovarian activity even though menstruation itself is suppressed; progestogen induced PMD where symptoms result from ovarian activity other than those resulting from ovulation; PMD with absent menstruation where symptoms result from exogenous progestogen administration [3]. Variant PMD has more complex characteristics that do not directly stem from a direct PMS diagnosis.

2.1. Symptoms of PMS

There are a vast number of documented symptoms of PMS that cover physical, psycho-emotional, and behavioral domains. The most common physical symptoms include abdominal cramps, abdominal bloating, tenderness and pain in the breasts, pain (back, head, muscle, joints), swelling of hands and feet, weight fluctuations, constipation, diarrhea, and fatigue [4][5][6][7][8]. Psycho-emotional symptoms include depressed mood, tendency to cry, irritability, emotional lability, anxiety, difficulty concentrating, anger, and mood swings [5][6][7][8]. Behavioral symptoms can stem from the consequences of physical and psych-emotional symptoms and/or stem from being PMS symptoms themselves. They can include changes in libido and in sexual desire, social withdrawal including from partner, family and friends, sensitivity, increased appetite, decreased interest in activities, restlessness, social phobia, and increased interpersonal conflict [4][5][6][9].
The severity and timing of this collection of symptoms varies per woman. There are other external factors, such as stress and illness, which could also exacerbate symptoms. For example, a woman may experience bloating and cramps several days before menstruation while the symptoms of irritability and anxiety could manifest on the day of menstruation. Add in an external stressor such as an exam or a big work deadline and other symptoms could manifest, or the present symptoms could worsen. Proper diagnosis of PMS involves keeping a record of symptom presence and severity so women and their healthcare providers can identify patterns and confirm the cyclic nature of symptoms. Given that most women in the United States go through 400 to 500 menstrual cycles in their lifetime, a consistently symptomatic woman experiencing PMS may spend 4 to 10 years of her life in a compromised physical, emotional, and psychological state [10]. Proper identification of symptoms and monitoring well-being throughout the menstrual cycle is key for optimal female health as PMS has been associated with decreased health-related quality of life [11].

2.2. Prevalence of PMS

Estimates for the prevalence of diagnosed PMS are varied and encompass a wide range from 12% reported in a study that surveyed 2800 French women [12], to 98.2% reported in a survey of 300 university students in Iran [13], with an average of 47.8% as reported in a meta-analysis of studies conducted across 17 countries [14]. However, many studies note that a larger percentage of women experience at least some premenstrual symptoms that could affect their daily life but not to the extent of having a complete PMS diagnosis. In addition, it should be noted that other factors such as race, ethnicity, and cultural norms surrounding menstruation can impact prevalence findings as well as how PMS impacts women. According to data from the World Health Organization (WHO), dysmenorrhea affects 1.7–97% of women and the percentage of women that experience more than one premenstrual symptom ranges from 20–40% [15].
It is difficult to provide a more robust estimation of PMS prevalence for a variety of reasons. First, the definition of PMS has only begun to solidify even though there are still some nuances depending on which organizational body the definition is coming from. Second, access to medical care, methods used to identify and diagnose PMS, self-diagnosis, self-medication, underlying diseases, cultural influences, and failure to report premenstrual symptoms due to social stigma and/or complacent acceptance that PMS is just what a woman goes through are potential reasons for the wide range in prevalence values. Nonetheless, premenstrual symptoms burden millions of women whether they constitute confirmed PMS or not, therefore, finding ways to enhance the discussion of women’s health and improve the quality of life of women through exercise could serve as a potent and welcomed way to alleviate PMS symptoms.

2.3. Impact of PMS

With up to 10 years of their lives spent in premenstrual distress, the impact PMS has on women does not solely affect their physical health, mental well-being, and psychological states. The effects permeate every aspect of a woman’s life. Compared to women without PMS, those with PMS have been reported to have more absent days from work and more days in which they struggle to complete work and school tasks which translates to lowered productivity [5][16]. Some women with PMS even report a poorer perception of their overall quality of life [17], as well as their work-related quality of life and decreased job career satisfaction levels [18]. A study has also shown that women with PMS have a 27.5% lower work performance and 23.1% perceived impairment of their working relationships [19]. University students also report that PMS significantly influences their daily activities and their ability to complete coursework, which directly impacts their educational endeavors [13][20].
These occupational and educational impacts of PMS come with direct and indirect economic consequences. Borenstein et al. [21] reported that direct medical costs of those with PMS average out to $210 ± $328 per year in outpatient medical visits, $16 ± $146 in laboratory services, and $59 ± 310 in radiology services. The large standard deviations presented demonstrate large variability in the direct costs to women which could be related to occupation type, access to quality medical care, social economic status, and other community-based factors. Some women may have hundreds of dollars of direct medical costs that add to the burden of having PMS. Indirectly, women with PMS lose an average of 15% of work productivity and 3.6 ± 7.8 h missed from work [21]. According to their model, PMS alone would cost women’s healthcare plans $174,936 per year in the United States. This is in addition to any other underlying condition a woman experiences or general health care costs.
Outside education and professional spaces, the indirect costs of PMS can be detrimental to self-esteem, and bring about depressed moods that could increase the sense of dissatisfaction and inadequacy, particularly in young women [22]. Interpersonal relationships can also undergo strain during the occurrence of PMS symptoms [23], bringing forth conflicts, controversies, and discomfort among partners, friends, and family [24], further impacting the quality of life and well-being in women. This distress demonstrates that PMS is a biopsychosocial phenomenon which demonstrates a critical need to support and manage the care of women as they undergo this cyclic pattern of symptoms that could deteriorate life quality.

2.4. Risk Factors of PMS

The role of potential genetic factors that increase the risk of premenstrual disorders is an active field of research that has not brought definitive conclusions. A study conducted by Miller et al. supported the relevance of estrogen receptor alpha (ESR-1) polymorphic variants in the regulation of affective state-independent personality traits in women with PMDD [25]. Later work in the area supported the consideration of ESR-1 to be used as a marker of PMS [26]. These studies call for future research to further explore potential genetic risk factors of PMS and other premenstrual disorders.
Another potential risk factor for PMS is the age of menarche or the age at which a girl experiences her first menstrual period. Studies have demonstrated that women with premenstrual disorders were younger during menarche compared to those without PMS [27]. In fact, the authors report an inverse relationship between the age of menarche and the risk of PMS symptoms [27]. Therefore, the younger a woman was when she first got her menstrual period, the greater the risk of developing or at the very least, having PMS symptoms. In addition, the early growth of pubic hair led to a 28% increased risk of premenstrual symptoms and PMD [27]. Based on this observation, it seems plausible that early menarche exposes the woman’s body to more ovulatory cycles and thus more hormone fluctuations that could lead them to be more susceptible to PMS and other PMD than those who experience menarche at an older age.
The impact of stress cannot be overlooked in the discussion of risk factors for premenstrual distress. In a broader sense, the existence of serious mood disorders, history of abuse, exposure to violence, and heightened stress levels due to occupation, education, and domestic demands could contribute to PMS [28]. Women with PMS experience an increased sensitivity to environmental stress and a heightened sensory perception that makes everyday activities more burdensome [29]. This information demonstrates that women with PMS are more susceptible to the negative consequences of stress and that stress itself can influence the severity of PMS symptoms. Such a situation poses the opportunity for exercise to serve as an invaluable tool not only to combat PMS directly but also through providing an avenue of stress relief that can improve the overall quality of life in women.


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