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Aetiology of premenstrual syndrome

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The cause is uncertain. Biological, genetic, psychological, environmental and social factors are thought to play an important role in the onset of symptoms (1,2).

  • cyclical ovarian activity has been shown to have a significant effect since pre menstrual syndrome (PMS) before puberty, in pregnancy and after the menopause is not seen (2)

  • a positive family history has been reported
    • around 70% of women with PMS symptoms had mothers who were affected when compared with 37% in women whose mothers have not been affected
    • 93% concordance rate in monozygotic twins when compared to 44 % in dizygotic twins (2)

It may become evident following childbirth or a disturbing life event.
An increased risk has been reported in

  • women who are obese, perform less exercise and are of lower academic achievements (3)
  • past, present or current domestic violence
  • younger women, black women
    • black women tend to have a higher prevalence of food cravings than white women while white women are more likely than black women to report premenstrual mood changes and weight gain
  • women with longer menstrual periods (2)

Lower incidence is seen in hormonal contraceptive users (1)


  1. The National Association for Premenstrual Syndrome (NAPS). Guidelines on Premenstrual Syndrome
  2. Khajehei M. Aetiology, Diagnosis and Management of Premenstrual Syndrome. J Pain Relief. 2015:4: 193
  3. Management of Premenstrual Syndrome: Green-top Guideline No. 48. BJOG. 2017;124(3):e73-e105.

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