Premenstrual Syndrome and Premenstrual Dysphoric Disorder

This page was last updated on Saturday July 07, 2007

The subject of this paper includes Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD). I will use the term ‘female’ when referring to women or girls. A girl is a female who has not attained the age of 21 years and a woman is a female who has attained the age of 21 years. I realize that this appears to be an arbitrary definition but having the right to vote upon attaining the age of 18 years is not the same thing as attaining the age of majority. The age of majority is the age where a person is legally responsible for their own activities and is entitled to the same legal rights held by every person who has attained the age of 21 years.

I wish to stress that diet and the overuse of growth hormones in plants and animals contribute to obesity and menstrual problems in females. Another problem is the widespread use of high fructose corn syrup in soft drinks and in certain fruit drinks such as lemonade, limeade, and fruit juices. Most naturally ripened fruit juices are sweet and do not require sweetening. The problem is that some fruits are picked before they have ripened and so artificial flavorings and high fructose corn syrup are used to mask the low quality of the product. Even cranberry juice is compromised by this method of production and I do not care much for the term ‘organic evaporated cane sugar’.

A structural isomer one of two or more substances that contain the same number and kinds of atoms but differ in their geometric arrangement. Dextrorotatory refers to the right-handed form (clockwise) and levorotary refers to the left-handed form (counterclockwise) of a structural isomer. Fructose is sweet levorotatory form of fructose that occurs especially in fruit juices and honey. Sucrose is a crystalline dextrorotatory disaccharide sugar that occurs naturally in most plants and is obtained from sugarcane or sugar beets.

The other problem is caffeine, a stimulant found in many soft drink beverages. It is used to promote the sale of soft drinks as a substitute for cocaine that was banned as an addictive substance some years ago. However, caffeine is also addictive and in large amounts, caffeine can cause racing heartbeats, heart palpitations, and seizures. Unlike cocaine addiction, caffeine addiction presents extremely mild or unnoticed withdrawal symptoms. Finding caffeine free soft drinks is difficult because soft drink makers want to increase sales of their products. So check the product’s label, it should state that the product does not contain caffeine or is caffeine free.

The diagnosis of menstrual problems often requires a complete physical and pelvic survey that may include invasive penetration but as I write, new imaging technologies may preclude the use of invasive penetration. This means that a virginal female might not have to give up her hymen, a fragile membrane that partially closes the opening of her vagina. I wish to stress the word ‘fragility’ for some females have never realized that they ever had a hymen. In the past, females were not allowed to ride a horse or use a bicycle as a man would do. The existence or non existence of a hymen is no indicator of a female’s character.

In the latter part of the 1970's (1977) Toxic Shock Syndrome became an issue. This is an acute disease that is associated with staphylococcus aurei, a bacterium that occurs in menstruating females using tampons. This condition presents the symptoms of nausea, fever, diffuse erythema (abnormal redness in the skin), premenstrual shock, and diarrhea. The misuse of the tampon by females led to this condition. It is normal to leak premenstrual blood in some amounts. However, in large amounts it may be an indicator of septic anemia that can lead to other problems such as blood insufficiently and anemia where the red blood cells and platelet cells are compromised (destroyed). The problem was that women did not understand that tampons occluded natural drainage. A normal hymen has perforations that allow menstrual blood to pass but an occluded hymen does not allow menstrual blood to pass. The important part is that every female should be examined by a physician for an occluded hymen. If the hymen is occluded, then the physician may puncture the hymen several times or remove the hymen to allow proper vaginal drainage.

This has nothing to do with female circumcision (the removal of a female’s clitoris) that the radical feminists have often blamed men for this unnatural practice. These ceremonial rituals are performed by the elder women in sub-Saharan Africa. I will not describe this ritual brutal ceremony more than I have described. This part of Africa is Islamic and these women believe that the practice of female circumcision is required by Islam. Circumcision is not mentioned in the Quran, the Muslim holy book.

Precocious puberty refers to the onset of puberty in girls who have not attained the age of 14 years and in boys who have not attained the age of 16 years. Unfortunately, dietary factors have adversely affected girls and boys so that the finding of precocious puberty now refers to girls and boys who have not attained the age of 12 years. The finding of precocious puberty, in girls and boys may drop to less than ten years. This can be the result of heredity, diet, and the overuse growth hormones in plant and animal products.

A female’s genital anatomy consists of two ovaries, one on the left side and the other on the right side. The ovaries are connected to the uterus by two fallopian tubes, one extending from the left ovary and the other extending from the right ovary. The uterus is connected to the vagina by the cervix, the narrow outer end of the uterus. The vagina is a canal that leads to an external orifice that is within the labia minora (smaller lips). The labia major (larger lips) encloses the labia minora (smaller lips), the urethra and the clitoris. The urethra is an opening that leads back to a bladder that holds urine. The clitoris is a small erectile organ that is homologous to the penis in males. The homology is that the clitoris in females and the penis in males is that they are both erectile organs. The urethra passes urine from the bladder and in males, the penis is also a conduit for semen.

Infections and cancer can occur in every part of a person’s body. In females, Endometrious is the presence and growth of functioning endometrial tissue that often results in infertility and severe pain. Normally, the top of the uterus tips toward the front (the anterior position) and this is seen from the front as a slight abdominal bulge. A prolapse uterus occurs when the uterus drops from its normal position in the pelvic cavity and descends into and sometimes outside of the vagina. This a very serious condition that must not be ignored because it gets worse over time.

Most authorities agree that if a female has not had her first menses by the time she has attained the age of 16 years, then she must be examined by a physician. The physician will check for abnormalities in the patient’s urogenital system. This may require probing, palpitation, visual inspection, x-ray imaging, and perhaps computer-aided imaging. This can be distressing to a child and the physician will take every care to make the examination comfortable as possible.

Some ancient societies equated a female’s menstrual cycle with the moon’s rotational period of 27 days, seven hours, 43 minutes, and 11 seconds. However, the moon’s orbital period about the earth can be slightly shorter or longer than its rotational period. This caused by the earth’s polar nutation (wobbling on its polar axis) and other perturbations caused by other objects as the earth orbits the sun. I first read about a lunar month more than 50 years ago (1956). It seemed that nearly everything in obstetrics was calculated in lunar months. The definition of a lunar month is called a lunation, the interval between one new moon and the next new moon. It is the period the moon takes to complete one complete revolution (orbit about the Earth) or about 29 days, 12 hours, 44 minutes, and 2.8 seconds, subject to perturbations. The Earth rotates faster on its axis than the Moon revolves about the Earth. So a new Moon is observable over several days. In some texts, the conclusion of a new Moon is represented by a crescent and the first appearance of a star. The national flags of Malaysia, Pakistan, and Turkey include this symbol. In some calendar months a full Moon appears twice in one month. The second full Moon is called a blue moon. There is no evidence that the Earth’s moon affects a female’s menstrual cycle.

The difference between a lunar month and the moon’s rotational period is about two days, five hours, and 51.8 seconds. Someone with very good eyes or have observed the moon through a telescope would notice the moon’s facing appearance is not the same. Sometimes, we can see more of the moon’s eastern regions and sometimes more of its western regions. My point is that a menstrual cycle of 28 days is an arbitrary notion. The menstrual cycle of a female can be shorter or longer than 28 days by some amount and vary from month to month. This why the rhythm method, a method of birth control involving abstinence during a female’s fertile cycle, often fails.

Certain impracticalities affect the exact measurement of female’s own menstrual cycle. She might not be aware that she is menstruating but she might remember the first day of her period. For an example, she retires for the night and awakes the next morning discovers and that she is in menses. This is the first day of her next menstrual period that can be 25 to 31 days to the first day of her next her menstrual period. This can be a problem for pubescent females and this requires attention and assurance that this is a normal event that can become more predictable over time. With older women, it is called perimenopause and the symptoms include hot flashes and menstrual irregularity.

Premenstrual Syndrome (PMS) occurs in the menstrual cycle between five and 11 days after ovulation. The symptoms usually stop when menstruation begins but sometimes the symptoms persist until the conclusion of the menstrual cycle.

Premenstrual Dysphoric Disorder (PMDD) is a condition that presents symptoms of irritability, depression, and tension. The symptoms of PMDD are more severe than those presented in PMS. It is a condition that is usually only present in females in their reproductive years. However, PMDD may occur anytime and the diagnosis of this condition requires a complete physical and psychiatric evaluation.

The symptoms of PMDD include persistent irritability or anger that affects others; disinterest in relationships; feeling out of control; sleep disturbances; mood swings; feelings of tension; feelings of anxiety; panic attacks; disinterest in daily activities; trouble concentrating; feelings of sadness; suicidal thoughts; food cravings; eating binges; fatigue; bloating, breast tenderness; headaches; joint pain; muscle pain; depression. Most authorities guess that between three and 10 percent of females with PMDD also exhibits the symptoms of Seasonal Affective Disorder.

Seasonal Affective Disorder (SAD) is a form of depression that typically occurs during fall or winter and improves during spring or summer. The fall and winter seasons are characterized by declining temperatures, decreasing sunlight, and increased precipitation. Spring and Summer months are characterized by increasing temperatures, increasing sunlight, and decreased precipitation. Many of us have heard the lament ‘rain, rain, go away, come again some other day’. Sunlight causes the production of Vitamin D in humans. Ultraviolet therapy could be a solution. Another solution is adding 1000 International Units (IU) of Vitamin D3 to the 400 (IU) recommended daily allowance of Vitamin D during the fall or winter months. Vitamin D3 is also called Cholecalciferol.

See Medline Plus, Medical Encyclopedia: Premenstrual Dysphoric Disorder.

Edward Steven Nunes