1. Premenstrual syndrome
Dr Felicia Molokoane

2. introduction
Premenstrual symptoms occur in 95% of all women of reproductive age
PMS occurs in 5% of those women
Terminology for premenstrual disorders has become complex
PMS commonly used
PMT is the lay term
PMDD is the extreme

3. definition
Recurrent psychological or somatic symptoms or both, recurring during luteal phase and resolving by end of menstruation

4. aetiology
Unknown
Seen in women of reproductive age, and is not seen before puberty, during pregnancy or after menopause.

5. diagnosis For the diagnosis of PMS, the symptoms must
Occur in the luteal phase of the cycle
Resolve by end of menstruation
Be severe enough to have major impact on normal functioning and
Have occurred in at least 4 of the 6 previous cycles

6. The character of the symptoms is less important than their timing and severity

7. management PMS does not seem to be caused by an endocrine imbalance.
Assessment
History: regularity of menstrual cycle
Physical examination
FBC, U&E, TSH
Record the symptoms for 2 months
Calendar for premenstrual experiences

8. DSM IV CRITERIA FOR PMDD
Prospective documentation of physical and behavioural symptoms being present most of the preceding year
Five or more symptoms must have been present during the week prior to menses
Resolve few days after menses starts

9. DSM IV CRITERIA FOR PMDD
Feeling of sad, hopeless, or self deprecating
Feeling tense, anxious or on edge
Marked lability of mood interspersed with frequent tearfulness
Persistent irritability, anger, and increased interpersonal conflicts
Decreased interest in usual activities
Difficulty concentrating
Feeling fatigue
Marked changes in appetite