PMS Classification

In an attempt to bring some order to the clinically and metabolically confusing picture of PMS, several experts have created classification systems that sort PMS sufferers into subgroups. The most generally accepted system was developed by Dr. Guy Abraham; it divides PMS into four distinct subgroups. Each subgroup is linked to specific symptoms, hormonal patterns, and metabolic abnormalities. Note that one rarely experiences a particular subgroup in a pure form; usually there is an overlap of one or more of the subgroups.

PMS-A (A = anxiety) is the most common symptom category and is found to be strongly associated with excessive estrogen and deficient progesterone levels during the premenstrual phase. Common symptoms of patients in this category are anxiety, irritability, and emotional instability.

PMS-C (C = carbohydrate craving) is associated with increased appetite, craving for sweets, headache, fatigue, fainting spells, and heart palpitations. Glucose tolerance tests (GTT) performed on PMS-C patients during the five to ten days before their menses show a flattening of the early part of the curve (which usually implies excessive secretion of insulin in response to sugar consumption), whereas during other parts of the menstrual cycle their GTT is normal. Currently, there is no clear explanation for this phenomenon, although an increased cellular capacity to bind insulin has been postulated. This increased binding capacity for insulin appears to be hormonally regulated, but other factors may also be involved, such as a high salt intake or decreased magnesium or prostaglandin levels.

PMS-D (D = depression) is the least common type and is relatively rare in its pure form. Its key symptom is depression, which is usually associated with low levels of neurotransmitters in the central nervous system. In PMS-D patients, this is probably due to increased breakdown of the neurotransmitters as a result of decreased levels of estrogen (in contrast to PMS-A, which shows the opposite results). The decreased ovarian estrogen output has been attributed to a stress-induced increase in adrenal androgen and/or progesterone secretion.

PMS-H (H = hyperhydration) is characterized by weight gain (greater than three pounds), abdominal bloating and discomfort, breast tenderness and congestion, and occasional swelling of the face, hands, and ankles. These symptoms are due to an increased fluid volume, secondary to an excess of the hormone aldosterone which causes increased fluid retention. Aldosterone excess during the premenstrual phase of PMS-H patients may arise due to stress, estrogen excess, magnesium deficiency, or excess salt intake.