Original Studies
Premenstrual Syndrome (PMS) in Adolescents: Severity and Impairment

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Abstract

Objectives

Identify the presence of patients with premenstrual syndrome (PMS) in an adolescent gynecology practice, and evaluate the reported severity, impairment and timing of the symptoms in the menstrual cycle.

Methods

Adolescents ages 13–18 years completed a symptom questionnaire, functional impairment ratings, and a brief medical history questionnaire during an office visit. Teens who responded that they had PMS and reported a premenstrual symptom score at least 50% greater than the postmenstrual score and rated moderate to severe impairment in one or more domains comprised the “PMS” group. Teens who responded that they had PMS but did not meet the symptom and impairment criteria were termed “PMS not supported.” Teens who responded that they did not have PMS and did not meet the PMS symptom and impairment criteria were termed “No PMS.”

Results

Study participants (n = 94) had a mean age of 16.5 years (±1.3 SD); 31% met the criteria for the PMS group, 54% said they had PMS but did not meet criteria, and 15% clearly had no PMS. In the PMS group, the most severe symptoms were mood swings, anxiety, and irritability, with the greatest impairment in the home/family domain. Dysmenorrhea and the duration of PMS were significantly associated (P < 0.01) with PMS in univariate and multivariate analyses.

Conclusions

The reports of premenstrual symptoms, their severity, timing and impairment suggest that PMS is common in adolescents. Further study is warranted to confirm these results with prospective assessment of PMS and to evaluate treatments for adolescents who have clinically significant PMS.

Introduction

Premenstrual syndrome (PMS) is a constellation of physical, mood and behavioral symptoms that are limited to the luteal phase, cause problems for the woman, and are not better explained by another diagnosis.1 It is a commonly accepted belief in medicine that adolescents suffer from dysmenorrhea, but that PMS is unusual in this young age group.2, 3, 4 Few studies have distinguished between PMS and dysmenorrhea in adolescents, and there continues to be scant information on adolescent PMS in the literature. These limitations and the continuing lack of differentiation between dysmenorrhea and PMS in young women may compromise effective treatment for these disorders.

The few reported studies of PMS in adolescents contradict the prevailing belief that PMS is neither distressing or common. An earlier study that assessed premenstrual symptoms in adolescents who were attending a health service (mean age 17.6 years) found that the most common mood and behavioral symptoms were impaired social function, depressive changes and autonomic physical changes. These reports were nearly identical to those of adult women who responded to the same Premenstrual Assessment Form (PAF).5 Another study of mothers and daughters likewise found that symptoms and symptom severity as assessed by the PAF did not differ between adolescents and adults, although the adolescents experienced more symptoms during the menstrual phase, due in part to dysmenorrhea.6 In a survey of high school adolescents (ages 14–18), 85% reported premenstrual symptoms, although 48% were mild, 27% were moderate, and only 11% were severe. Only one girl had obtained medical treatment for these symptoms.7 A recent report described three cases of adolescents diagnosed with premenstrual dysphoric disorder (PMDD), a severe form of PMS, and found that fluoxetine treatment led to a complete resolution of the symptoms.8

The objectives of the present study were to determine the presence of PMS in patients at an adolescent gynecology practice, and assess the severity of the reported symptoms and the extent to which the symptoms impaired functioning.

Section snippets

Subject Selection

Patients attending a primary-care adolescent gynecology practice during a 6-month period in 2004 were asked by their physician to complete a brief symptom questionnaire during an office visit. Approximately half the patient visits in the practice were contraceptive care or “well-patient” visits. Adolescents with no serious medical problems were the potential participants in the study. Other inclusion criteria were ages 13 to 18 years with regular menstrual periods in normal range (22–35 days).

Results

The mean age of the 94 participants was 16.5 years (±1.3 SD). Eighty-three percent were Caucasian, with the remainder African American (2%) or other/not reported (15%). In response to the questionnaire items, the mean duration that the teens had experienced PMS was 1.9 years (±2.2 SD). The mean age at menarche was 12.5 years (±1.7 SD), with a mean time from menarche to experiencing PMS symptoms of 1.9 years (±1.9 SD). Sixty-seven percent of the teens reported a family member with PMS.

Discussion

These findings indicate that although nearly two thirds of the teens said they had PMS when asked in a questionnaire, only 31% met the criteria for moderate to severe PMS when the reported severity, impairment, and timing of the symptoms were taken into consideration. These data show the importance of determining the severity of the symptoms and their relationship to the menstrual cycle, as numerous studies have shown.4 The results also challenge the belief that PMS is unusual in teenagers,

References (16)

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Presented in part at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology, New Orleans, LA, May 2005.

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