One tale about the cause states that a curse was placed on Eve in the Garden of Eden when she ate, and convinced Adam to eat fruit from the Forbidden Tree. In 'The Sickness of Virgins,' Hippocrates describes symptoms in relation to 'retained menstrual blood.' PMS as a diagnosis has also been used as a legal defence. In Victorian times, the lawyers for Miss Lizzie Borden pleaded that she did not pre-meditate her parents' murder, but was under the influence of 'that time of the month.'

It was not until the 1930s that medical circles began to agree that women do experience a variety of symptoms before their menstrual periods. PMS became recognized as a syndrome - not as a figment of imagination. Only recently, however, has PMS been given investigation and treatment.

What is PMS?

PMS has been defined as a set of emotional, behavioural and physical symptoms that occur in the latter half of the menstrual cycle. They disappear at the onset of menstrual flow. More than 150 symptoms are associated with PMS. Common ones include tension, irritability, depression, fatigue, headache, increased appetite, breast tenderness and fullness, abdominal pain, backache, mood swings and swelling. The effect of the symptoms vary from woman to woman and from cycle to cycle, making the diagnosis, cause and treatment of PMS difficult to pinpoint.

Some definitions of PMS group symptoms together. These are called clusters or PMS subgroups. Each sub-group may exist alone or with other groups. Many women may fit into more than one category of PMS during some cycles. The following are PMS sub-groups of the most common symptoms that women experience.

PMS - A: (Anxiety) This is the most common sub-group. The main complaints are anxiety, nervous tension, irritability and mood swings.

PMS - H: (Hydration) Main symptoms are weight gain, breast tenderness, swelling of hands and ankles and abdominal bloating.

PMS - C: (Craving) Women experience headaches, craving for sweets, increased appetite, heart pounding, fatigue and dizziness or fainting.

PMS - D: (Depression) The symptoms in this group include depression, poor memory, crying, confusion and poor sleep.

How common is PMS?

Most women (90 per cent) have some symptoms and changes of PMS. Symptoms range from mild to severe. Thirty to 40 per cent of women experience symptoms that are severely disturbing and interfere with their normal lives. Five to 10 per cent of these women are disabled. In such cases, PMS has been linked to serious problems including marital friction, divorce, suicidal tendencies, alcoholism, work absenteeism and child abuse. Women at greatest risk are those who are married, 30 to 40 years old, stress-ridden and with poor diet and exercise habits and women who have had many pregnancies.

What causes PMS?

Much research and many physiological, psychological and social theories have tried to explain why PMS occurs. Since the symptoms are so varied, no theory seems to fit all women. To date there is still doubt about the actual cause or causes of PMS. Both hormone and nutrition imbalances may contribute to the signs and symptoms of PMS.

Snack Smart

Healthy snacks can boost energy and nutrient intake. Try some of the following 100-calorie snack ideas:

Low fat cheese (25 grams, 1 ounce)
Whole-wheat bread with 1 tsp. peanut butter (5 ml)
Unsalted pretzels (six 3-ring)
Unsalted nuts or sunflower seeds (20 grams, 3/4 ounces)
Unsalted popcorn, air popped (4 cups)
Pumpkin, zucchini or banana bread (1 slice)
Graham crackers (3)
Unsweetened applesauce (1 cup, 250 ml)
Plain, skim milk yogurt (175 ml, 3/4 cup)
Apple, banana, orange or pear (1 - cut in pieces)
Vegetable (1 - 2 cups)
Unsalted, whole-grain crackers (5)
Small whole-wheat bagel or pancake (1)

Treatments for PMS

Treatments for PMS are as varied as the theories about the cause. Different treatments have been tried for the four sub-groups, each based on some notion of the cause of PMS. However, because of the mystery of the syndrome and the variety of symptoms, treatments also seem to be elusive. Some remedies include several different types of drugs, diuretics, psychotherapy, hormone treatments, sedatives, exercise, nutritional supplements and dietary changes.

The research into the role of nutrition in the cause and treatment of PMS has not yet given clear cut answers. However, although there has been little scientific evidence about the role of nutrition, many women have found that changing their diets and lifestyles can ease some symptoms of PMS. Along with the suggestion to increase exercise, the improvement of nutritional status seems to be a prudent first step in the attempts to reduce some of the discomforts of PMS.

Although many of the suggested changes in diet apply to the whole population, some of the more important ones for PMS sufferers are listed below.

Dietary Suggestions

Choose a variety of foods from Canada's Food Guide to Healthy Eating to meet nutrient needs. Include foods from the basic four food groups: grain products, vegetables and fruits, milk products, and meat and alternatives. As you choose a variety of foods, pay special attention to the following suggestions.

1. Eat plenty of complex carbohydrates

Choose whole-grain breads and cereals and a variety of fruits and vegetables. Five to 10 servings are recommended from the vegetable and fruit group daily. Examples of one serving include 1/2 cup, or one medium-size fruit or vegetable. Three to 12 servings are suggested from the grain group daily. One slice of bread, 1/2 cup of rice or pasta or 3/4 cup cereal are examples of one serving.

2. Avoid too much fat, saturated fat and cholesterol.

Choose lean meat, fish and poultry. Bake, barbecue, boil or broil meats instead of frying them. Trim meats and drain fat after frying. Choose lower-fat dairy products. Look for skim, one per cent or two per cent milk and yogurt. Read labels of cheese to find those made with skim or partly skimmed milk. Limit your intake of all fats, especially hard margarines, butter, shortening and lard. Use a variety of fats, including soft margarines and vegetable oils. Try to limit intake of high-fat snack foods such as potato chips and milkshakes.

3. Choose foods high in starch and fibre.

Substitute fruits and vegetables for their juices. Replace white bread and white rice with whole wheat bread and brown rice. Bake with whole wheat flour, bran and wheat germ. Use high fibre breakfast cereals and include legumes in meals.

4. Avoid excess sugar.

Reduce the amount of sugar used in baked products. Be aware that candy, soft drinks, ice cream, cakes and most cookies are high in sugar. Satisfy cravings for sweets with fruits and curb cravings with small, nutritious snacks.

5. Avoid too much sodium.

Limit the amount of salt used in cooking and at the table. Try herbs, spices or lemon juice in place of salt. Be cautious of highly salted processed foods.

6. Eat regular meals and snacks.

Three small meals and three small snacks daily will help keep nutrient and blood sugar levels stable. This may reduce fatigue and some cravings for sweets.

7. If you drink alcohol, drink in moderation.

Moderate alcohol consumption is no more than one drink a day and no more that seven drinks in a week. Examples of one drink are:

1 bottle (350 ml/12 oz.) of beer (5 per cent alcohol)
150 ml/5 oz. wine (10 to 14 per cent alcohol)
50 ml/1 1/2 oz. spirits (40 per cent alcohol).

8. Reduce the amount of caffeine in your diet.

Caffeine is found in many drugs and foods such as coffee, tea, cocoa, and cola drinks. To reduce caffeine, switch to herbal teas, decaffeinated coffee, and caffeine-free soft drinks. Some caffeine-free soft drinks are 7-Up, Sprite, Crush, Fresca, and Root Beer. Don't forget the importance of water as a beverage.

9. Follow Canada's Food Guide for adequate calcium.

Aim for three servings from the milk products group daily, with special attention to the lower fat choices.

10. Try a variety of protein sources.

Balance your intake of meat products with other protein sources such as dry, cooked beans, peas and lentils. These are low in fat, high in fibre and good sources of protein when combined with grain products.

Until the mystery of PMS is unravelled, women can adopt healthy eating habits, exercise regularly and strive for daily relaxation. Although these recommendations are not proven remedies for PMS, they are generally healthy measures and may help women feel better throughout the menstrual cycle.

Nutrition and the PMS Puzzle Eating better may help

History shows us that long before it was recognized and named, women experienced premenstrual syndrome. Ancient myths and bizarre tales through the ages have tried to explain the cause and offer comfort for the distress that revolves around the menstrual cycle.