Premenstrual Syndrome

Premenstrual syndromeis a cyclical disorder of young and middle-aged women, which is characterized by emotional and physical symptoms that consistently occur during the luteal phase of the menstrual cycle.

• Affective Symptoms: Depression, Sadness, Irritability, Anger, Anxiety, Tension, Appetite Change and Food Cravings, Change in sexual interest
• Cognitive Symptoms: Impaired concentration, confusion, forgetfulness, temper outburst
  
• Fluid Retention: Breast tenderness or swelling, weight gain, abdominal bloating or swelling, swelling of extremities
  
• General Somatic Symptoms: Fatigue, Dizziness, vertigo, nausea and insomnia
  

Women with more severe affective symptoms are classified as having premenstrual dysphoric disorder.

Aetiology:

• The role of ovarian hormones is unclear, but symptoms often improve when ovulation is suppressed.
• Some evidence suggests that the disorder is related to enhanced sensitivity to progesterone in women with underlying serotonin deficiency.

Management:

Premenstrual syndrome and premenstrual dysphoric disorder are diagnoses of exclusion; therefore, alternative explanations for symptoms must be considered before either diagnosis is made.

PMS also must be distinguished from simple premenstrual symptoms (e.g., bloating, breast tenderness) that do not interfere with daily functioning and are characteristic of normal ovulatory cycles.

When PMS or PMDD is suspected, patients should be instructed to keep a premenstrual daily symptom diary for several consecutive months.

Non-pharmacological Therapies: should be offered to all patients and includes education, supportive therapy, rest, exercise, dietary modifications such as low fat, high fibre diet with reduced salt, sugar and caffeine.

Pharmacologic Therapies:

• Selective Serotonin Reuptake Inhibitor - Administration only during the luteal phase decreases drug cost, minimizes drug exposure and side effects, and may be more acceptable to some women. For intermittent therapy, fluoxetine or sertraline can be given during the 14 days before the menstrual period, or treatment can be initiated just before the expected onset of symptoms.

• Diuretics - Spironolactone is the only diuretic that has been shown to effectively relieve PMS symptoms such as breast tenderness and fluid retention.

• Non-steroidal Anti-inflammatory Drugs - mefanamic acid and naproxen sodium have been the most studied.