Premenstrual Syndrome and Premenstrual Dysphoric Disorder

The Facts about the Menstrual Cycle

This page was last updated on Friday January 31, 2014

The Myths and The Moon

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. Nevertheless, the moon’s orbital period about the earth can be 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 they calculated nearly everything in obstetrics in lunar months. We call the definition of a lunar month 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.

Perturbations are simply changes in the orbital path of an object. They are associated with massive geological features such as mountains on the Earth and on the Moon. The alignment of the planets and their gravitational influence causes other perturbations. Moreover, the Sun’s gravitation attraction changes throughout the year. The reason for this is that the Earth’s orbit around the Sun is not precisely circular. This is why the calculation for predicting tides includes these anomalies.

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, a crescent and the first appearance of a star represent the conclusion of a new Moon. As an aside, the national flags of Malaysia, Pakistan, and Turkey include this symbol. In some calendar months a full Moon appears twice in one month. Most people call the second full Moon a blue moon. However, no evidence exists that proves that the Earth’s moon affects a female’s menstrual cycle. However, some women who live together may, in time, develop synchronous menstrual periods.

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 different. 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 through abstinence during a female’s fertile cycle, often fails.

Menstrual Problems

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. That is why it is not an indicator of a female’s character and besides that, it is no one's business.

In the latter part of the 1970's (1977) Toxic Shock Syndrome became an issue. This is an acute disease 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. Leaking small amounts of premenstrual blood is normal. Yet in large amounts it may be an indicator of septic anemia that can lead to other problems such as blood insufficiently and anemia where they compromise the red blood cells and platelet cells (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.  Homatocolpos is a medical condition where the vagina fills with menstrual blood that has drained from the uterus. Hematometria is a medical condition where the uterus fills with menstrual blood. A narrowing of the cervix causes this and this, in turn, may be a result of a surgical treatment. The important part is that a medical doctor should examine every female for an occluded hymen. If so, then the physician may puncture the hymen several times or remove the hymen to allow proper drainage. 

This has nothing to do with female circumcision (the removal of a female’s clitoris) that baneful women have often blamed men for this unnatural practice. In reality, the elder women in sub-Saharan Africa conduct these rituals. In this part of Africa these women believe that Islam requires the practice of infibulation and clitoridectomy. This is not true. These practices are a part of an older culture that predates Islam and the Qur’an does not mention it.

Precocious Puberty

Precocious puberty refers to the onset of puberty in girls who have not attained the age of 10-12 years and boys who have not attained the age of 12-14 years. Unfortunately, dietary factors have adversely affected girls and boys so that the finding of precocious puberty those persons who are less than 11-years-old and may drop lower. The onset of puberty has occurred children who were less than nine years old. This can be the result of heredity, diet, and the overuse growth hormones in plant and animal products.

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 a physician must examine her. 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. Although this can be distressing to a child, the medical staff will take every care to make the examination comfortable as possible.

A Female's Urinary - Genital Anatomy

A female’s genital anatomy consists of two ovaries, one on the left side and the other on the right side. Two separate fallopian tubes connect the ovaries to the uterus, one extending from the left ovary and the other extending from the right ovary. The cervix connects the uterus to the vagina, 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). Then 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 while the clitoris is a small erectile organ that is homologous to the penis in males.

In males, the urethra passes urine from the bladder through the penis to the outside. Now the prostate gland produces seminal fluid while the testes produce sperm. This means that the urethra also passes sperm and seminal fluid from the testes through the penis to the outside where it might enter the vagina of female. Also the testes secrete testosterone that is necessary for inducing and maintaining male sex characteristics.

Growths, Infections, and Cancer

Infections and cancer can occur in every part of a person’s body. In females, Endometriosis 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 appears 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 the vagina. This is a very serious medical condition and it gets worse over time.

Impracticalities PMS and PMDD

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 31days long. This can be a problem for pubescent females and this requires attention and assurance that menstruation is a normal event that can become more predictable over time. With older women, this phenomenon is a result of 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. 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

Seasonal Affective Disorder (SAD) is a form of depression that affects some persons and typically occurs during fall or winter and usually improves during spring or summer. Declining temperatures, decreasing sunlight, and increased precipitation characterizes the fall and winter seasons. Spring and increasing temperatures, increasing sunlight, and decreased precipitation has characterized Summer months. Many of us have heard the lament ‘rain, rain, go away, come again another day’. Sunlight causes the production of Vitamin D in humans and Ultraviolet therapy could be a solution.

When I first recommended increasing the dosage of Vitamin D some years ago, perhaps 2003, I knew 400 (IU) of vitamin D was only used to suppress rickets. Rickets is a disease that affects young children in their formative years of skeletal growth and is evident by soft and deformed bones caused by the body’s failure to assimilate calcium and phosphorous. This is associated with inadequate sunlight or vitamin D. Today, many practitioners are prescribing far more than 2000 (IU) of Vitamin D3. Current dosages now range between 2,000 and 10,000 (IU) and some researchers and practitioners are recommending higher dosages. Please consult with your physician or practitioner before increasing your dosage because each person body has its own requirements so what could be good for one person may not be good for another.



Characteristics of Women with Premenstrual Dysphoric Disorder

Depression in Women from the National Institutes of Mental Health (NIMH)

Premenstrual Dysphoric Disorder: MedlinePlus Medical Encyclopedia

Seasonal Affective Disorder (SAD): MedlinePlus Medical Encyclopedia

The Treatment of Premenstrual Dysphoric Disorder (PMDD)


Edward Steven Nunes