1. Premenstrual Syndrome (PMS) Slideshow Pictures
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3. What's Causing Your Pelvic Pain Slideshow Pictures

Medical Author:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

John P. Cunha, DO, FACOEP

John P. Cunha, DO, FACOEP

John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

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Premenstrual syndrome occurs during the luteal phase of the menstrual cycle. This phase occurs immediately after an egg is released from the ovary and lasts from day 14 through day 28 of a normal menstrual cycle (day one is the day a woman's period begins).

During the luteal phase, hormones from the ovary cause the lining of the uterus to grow thick and spongy. At the same time, an egg is released from the ovary. If the egg meets sperm, it may implant in the lining of the uterus and grow. At this time, the level of a hormone called progesterone increases in the body, while the level of another hormone, estrogen, begins to decrease. The shift from estrogen to progesterone may cause some of the symptoms of PMS.

PMS and PMDD are thought to result from an interaction between the changing sex hormone levels during the luteal phase of the menstrual cycle and neurotransmitters in the brain, particularly the neurotransmitter serotonin, in susceptible women. While hormone levels are generally normal in women with PMS, the individual's response to the hormones and their changing levels may be different or abnormal.

Hormonal cycling affects the level of serotonin, a brain chemical that regulates many functions, including mood and sensitivity to pain. Compared to women who do not have PMS, some women who experience PMS have lower levels of serotonin in their brains prior to their periods. (Low serotonin levels are commonly associated with depression. Popular selective serotonin reuptake inhibitor (SSRI) antidepressant medicines such as fluoxetine [Prozac], sertraline [Zoloft], and paroxetine [Paxil] lift depression by raising levels of serotonin in parts of the brain.)

• Bloating is a common symptom of PMS. This may occur because of cycling in hormones that affect the kidneys, the organs that control the balance of water and salt in the body. Fluid overload may cause some of the symptoms of PMS, especially swelling and weight gain, and may also aggravate some negative self perceptions, and thus worsen emotional symptoms at this stage of the menstrual cycle.
• Hormonal cycling also affects the level of serotonin, a brain chemical that regulates many functions, including mood and sensitivity to pain. Compared to women who do not have PMS, some women who experience PMS have lower levels of serotonin in their brains prior to their periods.

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