Premenstrual Syndrome (PMS)

“Premenstrual syndrome (PMS) refers to the range of
physical and emotional symptoms many women
experience in the lead-up to a period”.1

Umbrella
What may the Premenstrual Syndrome Umbrella include?

Depending on the Source (DotS) this Umbrella may include:

  • Premenstrual Dysphoric Disorder (PMDD)
  • Premenstrual Mood Changes
  • Premenstrual Syndrome (PMS)
  • Premenstrual Tension (PMT)

Premenstrual Changes

What are premenstrual changes?

DotS the definition of premenstrual changes may vary. The (United States Massachusetts General Hospital) MGH Center for Women’s Mental Health explain:

“Many women in their reproductive years experience transient physical and emotional changes around the time of their period. In fact, at least 90% of women with regular menstrual cycles report unpleasant physical or psychological symptoms premenstrually. For the majority of women, these symptoms are mild and tolerable. However, for a certain group of women, these symptoms can be disabling and may cause significant disruption in their lives”.2

Premenstrual Syndrome

What is premenstrual syndrome (PMS)?

DotS the definition of PMS may vary. The MGH Center for Women’s Mental Health’s definition is:

“Premenstrual Syndrome, commonly referred to as PMS, is a broad term that typically refers to a general pattern of physical, emotional and behavioral symptoms occurring 1-2 weeks before and remitting with the onset of menses”.3

The (Australian) Jean Hailes for Women’s Health’s (JH) definition is:

“Premenstrual syndrome (PMS) refers to the range of physical and emotional symptoms many women experience in the lead-up to a period”.4

The (United States) Medline Plus’s definition is:

“PMS refers to a wide range of physical or emotional symptoms that most often occur about 5 to 11 days before a woman starts her monthly menstrual cycle. In most cases, the symptoms stop when, or shortly after, her period begins”.5

PMS Symptoms

What are some PMS symptoms?

In Premenstrual Syndrome (PMS): Symptoms & Causes – Symptoms the (United States) Mayo Clinic reassure:

“The list of potential signs and symptoms for premenstrual syndrome is long, but most women only experience a few of these problems”.6

In Premenstrual Syndrome (PMS): What Are the Symptoms of PMS? the JH also note:

“Symptoms of PMS vary in intensity from woman to woman and can vary from one cycle to the next”.7

PMS Psychological Symptoms

What are PMS psychological/emotional symptoms?

In Premenstrual Syndrome (PMS): What Are the Symptoms of PMS? the JH elaborate on:

“Emotional Symptoms:

  • Irritability
  • Anxiety
  • Nervous tension
  • Lower coping ability
  • Difficulty concentrating
  • Wanting to be alone
  • Lower libido
  • Reduced interest in work and social life
  • Mood swings
  • Depression
  • Aggression
  • Sadness”.8

In PMDD/PMS: Premenstrual Syndrome (PMS) the MGH Center for Women’s Mental Health elaborate on:

“Psychological Symptoms:

  • Anger
  • Anxiety
  • Depression
  • Irritability
  • Sense of feeling overwhelmed
  • Sensitivity to rejection
  • Social withdrawal”.9

PMS Physical Symptoms

What are PMS physical symptoms?

In Premenstrual Syndrome (PMS): What Are the Symptoms of PMS? the JH elaborate on:

“Physical Symptoms:

  • Fluid retention (swollen fingers or ankles)
  • Bloating around the abdomen
  • Breast swelling and tenderness
  • Skin problems such as acne
  • Headaches and/or migraines
  • Poor coordination or clumsiness
  • Tiredness, lethargy, insomnia
  • Increase in weight
  • Constipation and/or diarrhea
  • Food cravings
  • Aches and pains”.10

In PMDD/PMS: Premenstrual Syndrome (PMS) the MGH Center for Women’s Mental Health elaborate on:

“Physical Symptoms:

  • Abdominal bloating
  • Appetite disturbance (usually increased)
  • Breast tenderness
  • Headaches
  • Lethargy or fatigue
  • Muscle aches and/or joint pain
  • Sleep disturbance (usually hypersomnia)
  • Swelling of extremities”.11

PMS Behavioural Symptoms

What are PMS behavioural symptoms?

In PMDD/PMS: Premenstrual Syndrome (PMS) the MGH Center for Women’s Mental Health elaborate on:

Behavioural Symptoms:

  • “Fatigue
  • Forgetfulness
  • Poor concentration”.12

PMS Common or Not

How common is PMS?

The MGH Center for Women’s Mental Health note:

“PMS is common, affecting from 30-80% of women of reproductive age, though clinically significant PMS symptoms have been reported in 3-8% of patients”.13

Premenstrual Dysphoric Disorder

What is premenstrual dysphoric disorder (PMDD)?

DotS the definition of PMDD may vary. The MGH Center for Women’s Mental Health’s definition is:

“Premenstrual Dysphoric Disorder (PMDD) is a more severe form of Premenstrual Syndrome characterized by significant premenstrual mood disturbance, often with prominent mood reactivity and irritability. Symptoms of PMDD can emerge 1-2 weeks preceding menses and typically resolve with the onset of menses. This mood disturbance results in marked social or occupational impairment, with its most prominent effects in interpersonal functioning”.14

In Learn: PMDD the International Association For Premenstrual Disorders (IAPMD) definition is:

“Premenstrual Dysphoric Disorder (PMDD) is a cyclical, hormone-based mood disorder with symptoms arising during the premenstrual, or luteal phase of the menstrual cycle and subsiding within a few days of menstruation. It affects an estimated 5.5% of women and AFAB individuals of reproductive age. While PMDD is directly connected to the menstrual cycle, it is not a hormone imbalance. PMDD is a severe negative reaction in the brain to the natural rise and fall of estrogen and progesterone. It is a suspected cellular disorder in the brain. Symptoms can worsen over time and or around reproductive events such as menarche (the first menstrual cycle), pregnancy, birth, miscarriage, and perimenopause”.15

Depression or Not

How is depression different to PMS and PMDD?

The JH explain:

“PMS and PMDD have similar symptoms to depression. However, with PMS and PMDD, the symptoms get better completely as soon as menstruation begins, while those of depression do not.

PMS and PMDD need to be distinguished from underlying depression because the treatments are different”.16

Premenstrual Exacerbation

What is premenstrual exacerbation (PME)?

DotS the definition of PME may vary. In PMDD/PMS: Ruling Out Other Psychiatric Illnesses the MGH Center for Women’s Mental Health explain:

“Mood disorders, such as major depression or bipolar disorder, can worsen during the premenstrual period and thus may mimic PMDD. When this occurs, the term premenstrual exacerbation or PME is used to refer to the mood worsening which occurs during the premenstrual phase. An estimated 40% of women who seek treatment for PMDD actually have a PME of an underlying mood disorder”.17

In Learn: PME the IAPM’s definition is:

“Premenstrual Exacerbation (PME) refers to the premenstrual exacerbation/worsening of the symptoms of another disorder, such as major depressive disorder or generalized anxiety disorder.

Premenstrual Dysphoric Disorder (PMDD) and Premenstrual Exacerbation (PME) are difficult to distinguish from each other”.18

Cause

What causes PMS?

In Premenstrual Syndrome and Premenstrual Dysphoric Disorder: Diagnosis and Prevention the (United States) Endocrine Society note:

“Doctors are still searching for the exact cause of premenstrual syndrome or PMDD. Hormone levels are the same in women with or without PMS/PMDD. But it is thought that women with PMS/PMDD have a greater response to the fall in hormones that occurs in the days before a period. There may also be changes in neurotransmitters in the brain. Some women have a genetic risk factor for PMDD. Undiagnosed depression or anxiety can also lead to problems”.19

Predictable PatternPremenstrual Syndrome (PMS)

Do PMS symptoms tend to recur in a predictable pattern?

Yes. The Mayo Clinic explain:

“Symptoms tend to recur in a predictable pattern. But the physical and emotional changes you experience with premenstrual syndrome may vary from just slightly noticeable all the way to intense”.20

Look for A PatternPremenstrual Syndrome (PMS)

How may I Look for A Pattern with PMS?

In Tracking Your Cycle & Symptoms the IAPMD explain:

“PMDD cannot be diagnosed via blood, hormone, or saliva test. These tests can, however, rule out any underlying disorders including hormone imbalance or thyroid issues. The only way to currently test for PMDD is by tracking symptoms for a span of two more menstrual cycles”.21

In Menstrual Diary the (United Kingdom) National Association for Premenstrual Syndrome explain:

“A completed menstrual chart is the first step towards understanding your own menstrual health”.22

The JH note:

  • “It can be useful to keep a detailed daily diary of at least two menstrual cycles to see if there is a pattern with your symptoms to help you and your doctor discuss the best treatment options for you”.23

The MGH Center for Women’s Mental Health also note:

“The best way to confirm the diagnosis of PMDD is by prospective daily charting of symptoms. Women with PMDD will experience a symptom-free interval between menses and ovulation (the proliferative phase)”.24

DiaryPremenstrual Syndrome (PMS)

Where may I find a diary to keep a record of any symptoms I have?

Your Country may have Links similar to:

Premenstrual Syndrome (PMS) Diary

Menopause

Is there an association between menopause and PMS?

The JH note:

Premenstrual Syndrome (PMS)
“Women can feel depressed and/or experience changes in their mood around perimenopause (the months/years before menopause) when their hormone levels fluctuate. Menopause does not cause depression, but women who have had depression before menopause, or who have a history of premenstrual syndrome (PMS), may be more sensitive to the hormonal changes that menopause brings”.25

In Premenstrual Syndrome (PMS): Does PMS Change With Age? the Office on Women’s Health, United States Department of Health and Human Services, Womenshealth.gov explain:

“Yes. PMS symptoms may get worse as you reach your late 30s or 40s and approach menopause and are in the transition to menopause, called perimenopause.

This is especially true for women whose moods are sensitive to changing hormone levels during the menstrual cycle. In the years leading up to menopause, your hormone levels also go up and down in an unpredictable way as your body slowly transitions to menopause. You may get the same mood changes, or they may get worse.

PMS stops after menopause when you no longer get a period”.26

Health Care Provider

What if I would like help with PMS, PMDD or PME?

If you would like help with PMS, PMDD or PME, it may be in your best interest to choose to talk to your health care provider about this. The Mayo Clinic explain:

“If you haven’t been able to manage your premenstrual syndrome with lifestyle changes and the symptoms of PMS are affecting your health and daily activities, see your doctor”.27

The JH note:

  • “If symptoms persist and interfere with daily activities, see your doctor or seek referral to a gynaecologist with expertise in PMS”.28

In PMS (Premenstrual Syndrome): Treating PMS the (United Kingdom) NHS (National Health Service) also note:

“As well as changes to your lifestyle, a GP can recommend treatments including:

  • Hormonal medicine – such as the combined contraceptive pill
  • Cognitive behavioural therapy – a talking therapy
  • Antidepressants
  • Dietary Supplements

If you still get symptoms after trying these treatments, you may be referred to a specialist.

This could be a gynaecologist, psychiatrist or counsellor”.29

Who is a GP?

DotS and DotC (Depending on the Country) a GP may be a qualified and registered general practitioner, a medical practitioner, a medical doctor or a doctor.

Health Topics A-Z

Where may I find Health Topics related to Premenstrual Syndrome?

In Health Topics A-Z you may find:

Health Topics A-Z

Links

Where may I find Premenstrual Syndrome Links?

Your Country may have Links similar to:

Links

This Links List to third party websites is neither comprehensive nor exhaustive. Inclusion on this Links List does not imply endorsement or recommendation. Non-inclusion on this Links List does not imply non-endorsement or non-recommendation. Third party websites are not under the control of Meno Martha International Menopause Directory. Third party websites may contain explicit medical images and/or sexual references. Please read Meno Martha International Menopause Directory’s Links Policy before proceeding to a Link. Please contact Webmaster if you experience a problem with a Link.

  1. 9 Things To Know About Your Hormones
  2. A Novel Treatment for PMDD: Ulipristal Acetate, A Progesterone Receptor Modulator
  3. About PMS
  4. Allopregnanolone Sparks Interest In New PMDD Treatment
  5. Breast Pain
  6. Can CBD Help Manage PMDD/PME?
  7. Chemical Menopause (GnRHa Treatment)
  8. Clearing the Fog
  9. Cognitive Behavioural Therapy (CBT)
  10. Depression In Women: 5 Things You Should Know
  11. Essential Reads: Ovarian Suppression for the Treatment of Severe PMDD
  12. Feeling Irritable? Why You’re Irritated and What To Do About It
  13. Frequently Asked Questions
  14. Glossary
  15. Healthy Living
  16. How Do We Know If We Have PME or PMDD? How Do We Differentiate?
  17. IAPMD Podcasts [International Association for Premenstrual Disorders]
  18. Iapmd.org [International Association for Premenstrual Disorders]
  19. Iapmd.org [International Association for Premenstrual Disorders]: Provider Directory
  20. Iapmd.org [International Association for Premenstrual Disorders]: What Is Your Question?
  21. In Brief: What’s the Connection Between Alcohol and Premenstrual Syndrome?
  22. Internet-Based Cognitive-Behavioural Therapy for Women With PMDD
  23. Learn [+ Podcasts]
  24. Mayo Mindfulness: What Does It Really Mean?
  25. Menopause Preparedness Toolkit Video Series: Understanding Menstrual Health and Menopause
  26. Menopause Preparedness Toolkit: A Woman’s Empowerment Guide
  27. Menstrual Cycle
  28. Menstrual Diary
  29. Menstruation
  30. Mittelschmerz
  31. National Center for Complementary and Integrative Health: Black Cohosh
  32. National Center for Complementary and Integrative Health: Chasteberry [Vitex]
  33. National Center for Complementary and Integrative Health: Evening Primrose Oil
  34. National Center for Complementary and Integrative Health: Herbs At A Glance
  35. National Center for Complementary and Integrative Health: How Safe Is This Product or Practice?
  36. National Center for Complementary and Integrative Health: Know the Science: How Medications and Supplements Can Interact
  37. Natural Therapies & Supplements
  38. PMD Awareness Month 2022: Connect The Dots [April]
  39. PMDD & the Workplace
  40. PMDD/PME Self Screen
  41. PMDD/PMS
  42. PMDD/PMS: Non-Pharmacologic Treatment for PMS and PMDD
  43. PMDD/PMS: Pharmacologic Treatment for PMS and PMDD
  44. PMDD/PMS: Premenstrual Dysphoric Disorder (PMDD)
  45. PMDD/PMS: Premenstrual Syndrome (PMS)
  46. PMS (Premenstrual Syndrome)
  47. PMS, PMDD and You
  48. Patient & Partner Resources: Overview
  49. Patient & Partner Resources: PMDD Symptom Tracker and Instructions
  50. Patient & Partner Resources: Provider Directory
  51. Perimenopause – Fact Sheet
  52. Period Pain & Symptom Diary
  53. Periods
  54. Periods – Fact Sheet
  55. Periods: Period Problems – Premenstrual Syndrome (PMS)
  56. Pms.org.uk [National Association for Premenstrual Syndromes, United Kingdom]
  57. Preliminary Data Supporting the Use of Mindfulness-Based Cognitive Therapy for Premenstrual Symptoms
  58. Premenstrual Disorders & Menopause
  59. Premenstrual Dysphoric Disorder
  60. Premenstrual Dysphoric Disorder (PMDD)
  61. Premenstrual Dysphoric Disorder (PMDD)
  62. Premenstrual Dysphoric Disorder: Different From PMS?
  63. Premenstrual Syndrome
  64. Premenstrual Syndrome
  65. Premenstrual Syndrome (PMS)
  66. Premenstrual Syndrome (PMS)
  67. Premenstrual Syndrome (PMS)
  68. Premenstrual Syndrome (PMS)
  69. Premenstrual Syndrome (PMS)
  70. Premenstrual Syndrome (PMS): Diagnosis & Treatment
  71. Premenstrual Syndrome (PMS): Management & Treatment of PMS Symptoms
  72. Premenstrual Syndrome (PMS): What Medicines Can Treat PMS Symptoms?
  73. Premenstrual Syndrome and Premenstrual Dysphoric Disorder
  74. Premenstrual Syndrome – Self Care
  75. Push Back Against PMS
  76. Reducing Stress
  77. Reducing Stress: Potential Stress Triggers
  78. Research Explained: Is There More Than One Type of PMDD?
  79. Steps To Diagnosis
  80. Surgery & Surgical Menopause for Premenstrual Disorders
  81. Tracking Your Cycle & Symptoms
  82. Transgender & PMDD
  83. Treating Premenstrual Dysphoric Disorder
  84. Treatment Options
  85. Tricky Periods: What’s ‘Normal’ and What’s Not
  86. Types of Talking Therapies: Cognitive Behavioural Therapy (CBT)
  87. Video Series-2019: Mood Changes During Perimenopause
  88. Video Series-2019: What You Need to Know About Mood During the Menopause Transition
  89. Video Series-2020: What You Need to Know About Cognition and Mood Changes
  90. Video Series-2022: Perimenopause, Signs, Symptoms, and Solutions
  91. Vitamins & Supplements
  92. What Is Chasteberry, and What Can It Do?
  93. What Is PMDD? [+ Podcast] What Is PMDD? A Bitesize Overview
  94. What Is PME?
  95. What Is the Relationship Between Hormones and Mental Health?
  96. Why Depression In Women Is So Misunderstood
  97. Women & Depression
  98. Womensmentalhealth.org [MGH Center for Women’s Mental Health, Massachusetts General Hospital]
  99. Womensmentalhealth.org [MGH Center for Women’s Mental Health, Massachusetts General Hospital]: Menopausal Symptoms
  100. Women’s Health: In-Depth – Water Retention: Relieve This Premenstrual Symptom

Sources

Where may I find the Sources quoted?

You may find the Sources quoted at:

Sources

  1. Premenstrual Syndrome (PMS). Last Updated: 18 November 2020 | Last Reviewed: 10 July 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/periods/premenstrual-syndrome-pms/ Accessed: 07 September 2022
  2. PMDD/PMS: Premenstrual Mood Changes. MGH Center for Women’s Mental Health https://womensmentalhealth.org/specialty-clinics-2/pms-and-pmdd/ Accessed: 07 September 2022
  3. PMDD/PMS: Premenstrual Syndrome (PMS). MGH Center for Women’s Mental Health https://womensmentalhealth.org/specialty-clinics-2/pms-and-pmdd/ Accessed: 07 September 2022
  4. Premenstrual Syndrome (PMS). Last Updated: 18 November 2020 | Last Reviewed: 10 July 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/periods/premenstrual-syndrome-pms/ Accessed: 07 September 2022
  5. Premenstrual Dysphoric Disorder. Review Date: 03 December 2020. Medline Plus https://medlineplus.gov/ency/article/007193.htm Accessed: 07 September 2022
  6. Premenstrual Syndrome (PMS): Symptoms & Causes – Symptoms. 25 February 2022. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/symptoms-causes/syc-20376780 Accessed: 07 September 2022
  7. Premenstrual Syndrome (PMS): What Are the Symptoms of PMS? Last Updated: 18 November 2020 | Last Reviewed: 10 July 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/periods/premenstrual-syndrome-pms/ Accessed: 07 September 2022
  8. Premenstrual Syndrome (PMS): What Are the Symptoms of PMS? Last Updated: 18 November 2020 | Last Reviewed: 10 July 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/periods/premenstrual-syndrome-pms/ Accessed: 07 September 2022
  9. PMDD/PMS: Premenstrual Syndrome (PMS). MGH Center for Women’s Mental Health https://womensmentalhealth.org/specialty-clinics-2/pms-and-pmdd/ Accessed: 07 September 2022
  10. Premenstrual Syndrome (PMS): What Are the Symptoms of PMS? Last Updated: 18 November 2020 | Last Reviewed: 10 July 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/periods/premenstrual-syndrome-pms/ Accessed: 07 September 2022
  11. PMDD/PMS: Premenstrual Syndrome (PMS). MGH Center for Women’s Mental Health https://womensmentalhealth.org/specialty-clinics-2/pms-and-pmdd/ Accessed: 07 September 2022
  12. PMDD/PMS: Premenstrual Syndrome (PMS). MGH Center for Women’s Mental Health https://womensmentalhealth.org/specialty-clinics-2/pms-and-pmdd/ Accessed: 07 September 2022
  13. PMDD/PMS: Premenstrual Syndrome (PMS). MGH Center for Women’s Mental Health https://womensmentalhealth.org/specialty-clinics-2/pms-and-pmdd/ Accessed: 07 September 2022
  14. PMDD/PMS: Premenstrual Dysphoric Disorder (PMDD). MGH Center for Women’s Mental Health https://womensmentalhealth.org/specialty-clinics-2/pms-and-pmdd/ Accessed: 07 September 2022
  15. Learn: PMDD. International Association For Premenstrual Disorders https://iapmd.org/pam-learn Accessed: 07 September 2022
  16. Premenstrual Syndrome (PMS): How Are PMS & PMDD Different From Depression? Last Updated: 18 November 2020 | Last Reviewed: 10 July 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/periods/premenstrual-syndrome-pms/ Accessed: 07 September 2022
  17. PMDD/PMS: Ruling Out Other Psychiatric Illnesses. MGH Center for Women’s Mental Health https://womensmentalhealth.org/specialty-clinics-2/pms-and-pmdd/ Accessed: 07 September 2022
  18. Learn: PME. International Association For Premenstrual Disorders https://iapmd.org/pam-learn Accessed: 07 September 2022
  19. Premenstrual Syndrome and Premenstrual Dysphoric Disorder: Diagnosis and Prevention: 24 January 2022. Endocrine Society https://www.endocrine.org/patient-engagement/endocrine-library/pms-and-pmdd Accessed: 07 September 2022
  20. Premenstrual Syndrome (PMS): Symptoms & Causes – Overview. 25 February 2022. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/symptoms-causes/syc-20376780 Accessed: 07 September 2022
  21. Tracking Your Cycle & Symptom. International Association for Premenstrual Disorders https://iapmd.org/symptom-tracker Accessed: 07 September 2022
  22. Menstrual Diary. National Association for Premenstrual Syndromes https://www.pms.org.uk/support/menstrual-diary/ Accessed: 07 September 2022
  23. Premenstrual Syndrome (PMS): Management & Treatment of PMS Symptoms – Things To Keep In Mind. Last Updated: 18 November 2020 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/periods/premenstrual-syndrome-pms/ Accessed: 07 September 2022
  24. PMDD/PMS: Non-Pharmacologic Treatment for PMS and PMDD – Monthly Mood Charting. MGH Center for Women’s Mental Health https://womensmentalhealth.org/specialty-clinics-2/pms-and-pmdd/ Accessed: 07 September 2022
  25. Symptoms of Menopause: Menopause & Mood. Last Updated: 24 March 2021 | Last Reviewed: 17 December 2017. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/menopause/menopause-symptoms Accessed: 07 September 2022
  26. Premenstrual Syndrome (PMS): Does PMS Change With Age? Page Last Updated: 22 February 2022. Office on Women’s Health, United States Department of Health and Human Services, Womenshealth.gov https://www.womenshealth.gov/menstrual-cycle/premenstrual-syndrome Accessed: 07 September 2022
  27. Premenstrual Syndrome (PMS): Symptoms & Causes – Symptoms: When To See A Doctor. 07 February 2022. Mayo Clinic https://www.mayoclinic.org/diseases-conditions/premenstrual-syndrome/symptoms-causes/syc-20376780 Accessed: 07 September 2022
  28. Premenstrual Syndrome (PMS): Management & Treatment of PMS Symptoms – Things To Keep In Mind. Last Updated: 18 November 2020 | Last Reviewed: 10 July 2018. Jean Hailes for Women’s Health https://jeanhailes.org.au/health-a-z/periods/premenstrual-syndrome-pms/ Accessed: 07 September 2022
  29. (PMS) Premenstrual Syndrome: Treating PMS. Page Last Reviewed: 09 June 2021. NHS https://www.nhs.uk/conditions/pre-menstrual-syndrome/ Accessed: 07 September 2022
Topic Last Updated: 24 November 2022 – Topic Last Reviewed: 07 September 2022

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