PREMENSTRUAL SYNDROME

INTRODUCTION Many women experience mood and behavioral changes during the premenstrual phase. Many present with self-diagnosed “PMS”. No specific hormonal levels, markers or treatment associated with PMS.

DEFINITION Cyclical appearance of psychological and/or physical symptoms in the premenstrual period with disappearance in the post-menstrual period, for at least 3 subsequent menstrual periods. Criteria – Magos and Studd

Primary PMS Non-specific somatic, psychological and/or behavioral Sx Sx resolve completely at the end of menstruation, leaving a Sx free week

Secondary PMS Non-specific somatic, psychological and/or behavioral Sx Sx significantly improve, but do not completely resolve at the end of menstruation Sx improvement should be sustained for at least one week

INCIDENCE The prevalence is difficult to assess. 20-30% or more. 1/3 symptoms severe enough to interfere with interpersonal relationships. About 3-5% of all women suffer symptoms so debilitating that they warrant a psychiatric diagnosis of premenstrual dysphoria.

CLINICAL PRESENTATION Over 180 different symptoms are included in the presentation of PMS. The symptoms fall essentially in 3 groups: Physical Psychological Behavioral The most common symptoms.

ETIOLOGY STILL NO GENERALLY ACCEPTED THEORY. Social and personal problems, previous child abuse, marital disharmony, poor work performance, suicide and criminal acts. Current theories: P, E, Vit B6, PRL, endogenous opiates, PG, cyclical ovarian activity. RECENT STUDIES: alterations in the serotinergic neuronal mechanisms.

DIAGNOSIS Exclude other conditions. Symptom diary – recording exact dates of menstruation with the daily occurrence of the patient’s symptoms together with the severity and weight. Record the 3 most worrying symptoms. Continue with this dairy during treatment. Psychiatric evaluation.

PMS(PMT) symptom cluster groups PMT-A Irritability, anxiety, anxious PMT-H Weight gain, abd bloating, mastalgia PMT-C Headache, fatigue, palpitations, increased appetite and food cravings PMT-D Depression, withdrawal and suicidal ideation

MANAGEMENT AND TREATMENT CONSERVATIVE MANAGEMENT Explanation, eliminate fear, coping skills, dietary advice, exercise, stress reduction. MEDICATION Only when above measures fail to control. Diet supplementation, NSAIDs, OC, bromocriptine (mastalgia Rx), psycoactive drugs, hormone therapy: Drosperinone (Yasmin) Ovulation suppression spirinolactone SURGERY ONLY IN SELECTIVE CASES