600

cLrMcAL REpRoDUCTTw ENDocRrNoLocy

Psychological symptoms
Table 32.1 lists the maiority of the important psychological slrnptoas rhar have been described; the more common of tl*se sbr:.}d be considered. Dep=si,on is commonlv reported and may present in sereral =z,rs from premenstrual crying bouts to sadness =ed deq <iepression, parasuicide and actual suicide. Some

direcrion some \tomen have more orr-uat drive and in others it - diminished. A parricular problem is that of is ciumsiness, ioabilitl' to concenrrare and inability to perform tasks as u-ell, which mat lead to poorer perform_ ance at q-ork or rvhen driving. Hot-eler, the evidence to

-rcer:tcng dara is rhat b1' IlacKinnon & MacKinnon j956) rrhr-r studied posrmonem urerine specimens in G-o:rleE s-ho had successfulll, csmmirred suicide. They saou'ed rhai in the maioritv of u,omen the histolog_v of the eldoaerium u'as in the.lsecretory phase of the cvcle. Tension aud anriiety are also commonll. ,.porr.d. Th... p"l't* changes in appetite and sleep patrern> parricularly iasomnia, libido changes, rhough this mav be in eithei

diagnosing the syndrome (Brahams, l98I)- patients accused of murder and arson have recently had their sentences drastically reduced on the basis of their temporary inability to control themselves, due to the supposed lack of progesterone during the premensrum. Io the most recent case on these lines the defending counsel attempted to align the case with a woman sufferiug from hypoglycaemia due to excessive insulin adminisuation (which had previously been proven in 1973). This appeal failed. The Judge concluded rhat ir was the dut1, of the court to protect the public and that ir would be mosr undesirable for a woman suffering from pMS and prone to violence to be able to go out and commit a series of offences without restraint. This lady had had 45 previous convictions, apparently many of which had occurred in the
premenstrual phase.

Premenstrual syndrome has also been related

\;e iiar= previousll- said that the most commonly reportei group of s,'mproms is the irritability and agg.e.sion ryp,e of smptom. This may range from the ,rr.oppy, intoleranr aititude ro*,ards children and the *o*an, husbaad. It ma-v- be \4'orse, and manifest itself as violent arrack. It has been claimed that this may be so severe as Io cause inra-familial discord, child battering and violent crime- The evidence on uhich these assumptions are made is nor *'ho111' convincing, bur even so, british law has receatll' recognised premensuual svndrome as mitigation in several crimes, even though ...a h"ra no exact means of
Table 32.1 Slmptoms of premenstrual svndrome
Psychological s!.mptoms

suppclri rids is largeiv anecdotal.

increased number of psychiatric admissions; these have usually been exacerbations of previous psychiatric problems (Janowsky et al, 1969). Alcohol abuse has also been shown to increase in the premenstrual phase (Belfer et al: 1971). There are many other supposed consequences ofthe syndrome; the majority are based on inadequate evidence.

to

an

Effict on worh and pedormance

There is some evidence to suggest that concentration, dexterity, and thus performance in school, work and sporrs are impaired premenstrually. Dalton reports deterioration of schoolgirls' weekly grades and examination results in the paramenstruum (Dalton, 1977). There also appears to be a decline in industrial and sporting performance (Humke, 1968; Redgrove, l97l) and the effect on industry is further aggravated by the grearer incidence of absenteeism premenstrually (Dalton, tiZ;;. Road accidents appear to be more frequenr premen_ strually (Landauer, 1974; Dalton, 1977) and tu,o inlesd_ gators have concluded that women pilots should not be permitted to fly before or during menstruation (Humke. 1968; Landauer, 1974).
Somatic symptoms Apart from the well-known mood and behavioural changes
described above, there are also many physical and somadc symptoms associated with the syndrome (Table ji.l -

Irritabiliry
Aggression

Tension

.{nxieq'
Depression

Lerhargl'
Insomnia
Change

in appetite

Crying
Change

in libido

Thirst
Loss of concentration Poor coordinariory'clumsiness/accidents

Somatic symptoms
Feeling 'bloated' Feeling of weight increase Breast pain/tenderness Swelling of ankles Skin disorders

Typically, women complain of a feeling of bloatedness.

weight increase (or a feeling of weight increase), peripheral swelling, water retenrion symptoms, breasr swelling and pain and also headache and premensrrual pelvic pain. There may also occasionally be skin symptoms such as exacerbation of eczema and in many women acne occurs

Hot flushes
Headache

Pelvic pain
Change

premenstrually. Urinary retention (and occasionalll.'

in bowel habit

frequenry) and constipation are occasionally reported and one or two women complain of hot flushes. Since bloated-