出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/12 10:08:10」(JST)
Premenstrual syndrome (PMS) refers to a varied collection of physical and emotional symptoms during part of a woman's menstrual cycle. While most women of child-bearing age (up to 85%) report having experienced physical symptoms related to normal ovulatory function; medical treatment of PMS is limited to a consistent pattern of emotional and physical symptoms that are of "sufficient severity to interfere with some aspects of life".[1] The specific emotional and physical symptoms attributable to PMS vary from woman to woman, but each individual woman's pattern of symptoms is predictable, occurs consistently during the ten days prior to the start of the menstrual period, and vanishes either shortly before or shortly after the start of menstrual flow.
Two to ten percent of women have significant premenstrual symptoms that are separate from the normal discomfort associated with menstruation in healthy women.[1][2]Premenstrual dysphoric disorder (PMDD) consists of symptoms similar to, but more severe than, PMS. Primarily mood-related, PMDD may include physical symptoms as well. PMDD is classified as a repeating transitory cyclic disorder with similarities to unipolar depression, and several antidepressants have been approved as therapy.[3]
More than 200 different symptoms have been associated with PMS. Common emotional and non-specific symptoms include stress, anxiety, difficulty in falling asleep (insomnia), headache, fatigue, mood swings, increased emotional sensitivity, and changes in libido.[4]
Physical symptoms associated with the menstrual cycle include bloating, lower back pain, abdominal cramps, constipation/diarrhea, swelling or tenderness in the breasts, cyclic acne, and joint or muscle pain, food cravings, [5] The exact symptoms and their intensity vary significantly from woman to woman, and even somewhat from cycle to cycle. Most women with premenstrual syndrome experience only a few of the possible symptoms, in a relatively predictable pattern.[6]
While PMS is linked to the luteal phase, the causes of PMS are not clear, but several factors may be involved. Changes in hormones during the menstrual cycle seem to be an important factor; changing hormone levels affect some women more than others. Chemical changes in the brain, stress, and emotional problems, such as depression, do not seem to cause PMS but they may make it worse. Low levels of vitamins and minerals, high sodium, alcohol, and/or caffeine can exacerbate symptoms such as water retention and bloating. PMS occurs more often in women who are between their late 20s and early 40s; have at least 1 child; have a family history of depression; and have a past medical history of either postpartum depression or a mood disorder.
There is a wide range of estimates of how many women suffer from PMS. The American College of Obstetricians and Gynecologists estimates that at least 85 percent of menstruating women have at least 1 PMS symptom as part of their monthly cycle. Most of these women have fairly mild symptoms that do not need treatment. Others (about 3 to 8 percent) have a more severe form of PMS, called premenstrual dysphoric disorder (PMDD).[7]
Mild PMS is common, and more severe symptoms would qualify as PMDD. PMS is not listed in the DSM-IV, unlike PMDD. To establish a pattern and determine if it is PMDD, a woman's physician may ask her to keep a prospective record of her symptoms on a calendar for at least two menstrual cycles.[6] This will help to establish if the symptoms are, indeed, limited to the premenstrual time, predictably recurring, and disruptive to normal functioning. A number of standardized instruments have been developed to describe PMS, including the Calendar of Premenstrual syndrome Experiences (COPE), the Prospective Record of the Impact and Severity of Menstruation (PRISM), and the Visual Analogue Scales (VAS).[1]
Other conditions that may better explain symptoms must be excluded.[1] A number of medical conditions are subject to exacerbation at menstruation, a process called menstrual magnification. These conditions may lead the woman to believe that she has PMS, when the underlying disorder may be some other problem, such as anemia, hypothyroidism, eating disorders and substance abuse.[1] A key feature is that these conditions may also be present outside of the luteal phase. Conditions that can be magnified perimenstrually include depression or other affective disorders, migraine, seizure disorders, fatigue, irritable bowel syndrome, asthma, and allergies.[1] Problems with other aspects of the female reproductive system must be excluded, including dysmenorrhea (pain during the menstrual period, rather than before it), endometriosis, perimenopause, and adverse effects produced by oral contraceptive pills.[1]
The National Institute of Mental Health research definition compares the intensity of symptoms from cycle days 5 to 10 to the six-day interval before the onset of the menstrual period.[1] To qualify as PMS, symptom intensity must increase at least 30% in the six days before menstruation. Additionally, this pattern must be documented for at least two consecutive cycles.
Many at-home treatments have been offered for PMS, including diet, exercise, or over the counter pills. Aerobic exercise has been found in some studies to be helpful.[1] Some PMS symptoms may be relieved by leading a healthy lifestyle: Reduction of caffeine, sugar, and sodium intake and increase of fiber, and adequate rest and sleep.[8] Non-steroidal anti-inflammatory drugs (NSAIDs; e.g. ibuprofen) have been used to treat pain.
Medical interventions are primarily concerned with hormonal intervention and use of selective serotonin reuptake inhibitors (SSRIs):
PMS is generally a stable diagnosis, with susceptible women experiencing the same symptoms at the same intensity near the end of each cycle for years.[21]Treatment for specific symptoms is usually effective. Even without treatment, symptoms tend to decrease in perimenopausal women.[22]
PMS was originally seen as an imagined disease. Women who reported its symptoms were often told it was "all in their head".[23] Woman’s reproductive organs were thought to have complete control over them. Women were warned not to divert needed energy away from the uterus and ovaries. This view of limited energy ran very quickly up against a reality in 19th century America that young girls worked extremely long and hard hours in factories; newspapers in the 19th century were peppered with remedies to help in the “tyrannous processes” of the menstrual cycle. In 1873 Edward Clarke published an influential book titled “Sex in Education”. Clarke came to a conclusion that female operatives suffer less than schoolgirls because they “work their brain less”. This suggested that they have stronger bodies and a stronger reproductive “apparatus more normally constructed”. Feminists later took opposition to Clarke’s argument that women should not leave the private sphere by showing how woman could function in the world outside the home in spite of their bodily functions.
The formal medical description of premenstrual syndrome (PMS) and the more severe, related diagnosis of premenstrual dysphoric disorder (PMDD) goes back at least 70 years to a paper presented at the New York Academy of Medicine by Robert T. Frank titled “Hormonal Causes of Premenstrual Tension.” The specific term premenstrual syndrome appears to date from an article published in 1953 by Dalton and Green in the British Medical Journal.1 Since then, PMS has been a continuous presence in our popular culture, occupying a place that is larger than the research attention accorded it as a medical diagnosis.It is argued that women are partially responsible for the medicalization of PMS.[24] By legitimizing this disorder, women have contributed to the social construction of PMS as an illness. It has also been suggested that the public debate over PMS and PMDD was impacted by organizations who had a stake in the outcome including feminists, the APA, physicians and scientists.[25] Up until this point, there was little research done surrounding PMS and it was not seen as a social problem. By the 1980s, however, viewing PMS in a social context had begun to take place.
Most supporters of PMS as a social construct believe PMDD and PMS to be unrelated issues: according to them, PMDD is a product of brain chemistry, and PMS is a product of a hypochondriatic culture. Most studies on PMS and PMDD rely solely on self-reporting. According to sociologist Carol Tavris, Western women are socially conditioned to expect PMS or to at least know of its existence, and they therefore report their symptoms accordingly.[26] The anthropologist Emily Martin argues that PMS is a cultural phenomenon that continues to grow in a positive feedback loop, and thus is a social construction that contributes to learned helplessness or convenient excuse. Tavris says that PMS is blamed as an explanation for rage or sadness.[27] The decision to call PMDD an illness has been criticized as inappropriate medicalization.[28] In both cases, they are referring to the emotional aspects, not the normal physical symptoms that are subjectively present.
During the luteal phase, the hormone estrogen production drops off severely, a common symptom of which is lowered mood.[29]
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| リンク元 | 「月経前症候群」「月経前緊張症」「premenstrual tension」「PMS」 |
| 関連記事 | 「syndrome」 |
[★] 月経前症候群 premenstrual syndrome