This condition is mentioned in the fourth century BC by Hippocratic but became a medical epidemic in the nineteenth century. “The monthly activity of the ovaries which marks the advent of puberty in women has a notable effect upon the mind and body; wherefore it may become an important cause of mental and physical derangement…" This and other female maladies were recognised, rightly or wrongly, to be due to the ovaries.
Severe premenstrual syndrome (PMS) is a poorly understood collection of cyclical symptoms, which cause considerable psychological and physical distress. The psychological symptoms of depression, loss of energy, irritability, loss of libido and abnormal behaviour as well as the physical symptoms of headaches, breast discomfort and abdominal bloating may occur for up to 14 days each month. There may also be associated menstrual problems, pelvic pain, menstrual headaches and the woman may only enjoy as few as 7 good days per month. It is obvious that the symptoms mentioned can have a significant impact on the day-to-day functioning of women. It is estimated that up to 95% of women have some form of PMS but in about 5% of women of reproductive age they will be affected severely with disruption of their daily activities. Considering these figures it is disturbing that many of the consultations at our specialist PMS clinics start with women saying that for many years they have been told that there are no treatments available and that they should simply "live with it".
The exact cause is uncertain but fundamentally it is due to the hormonal or biochemical changes, (whatever they are with ovulation), and the resulting complex interaction between ovarian steroids and neuro-endocrine factors that occur with ovulation. This combination produces these varied symptoms in women who are somehow vulnerable to changes in their normal hormone levels. These cyclical chemical changes, probably due to progesterone or one of its metabolites, produce the cyclical symptoms of PMS.