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Premenstrual Syndrome

Premenstrual Syndrome (PMS) is a cyclic disorder characterized by behavioral, emotional, and physical symptoms during the luteal phase of the menstrual cycle (the 5-11 days before menses). Emotional manifestations include irritability, depression, hostility, and social withdrawal. Physical complaints include bloating, breast tenderness, myalgia, and headache.

Clinical Evaluation of Premenstrual Syndrome

It only occurs during ovulatory cycles. Ovulatory cycles are characterized by a regular intermenstrual interval.

Emotional/Behavioral Symptoms. Anxiety, altered libido, anger, depression, food cravings, insomnia, irritability, panic attacks, poor concentration, reduced coping skills,

Physical Symptoms. Abdominal bloating, breast swelling or tenderness, constipation, dizziness, fatigue, fluid retention, headaches, hot flashes, and muscle aches.

Physical Examination. Coexisting medical disorders or evidence of hypertension, hirsutism, or striae should be identified.

Laboratory Evaluation

Testing to Identify Clinically Suspected Disorders

Gonococcal and chlamydia culture, HIV antibody (if risk factors).

Serum prolactin level (if galactorrhea or irregular menstrual cycles or atypical mastalgia).

Measure FSH and LH levels if over 40 years of age, or if hot flashes or irregular menses.

Thyroid-stimulating hormone and complete blood count are checked if menorrhagia or chronic fatigue premenstral.


Recommended dietary changes (especially during the luteal phase) should include the reduction or limitation of tobacco, chocolate, caffeine, and alcohol. Small, frequent complex carbohydrate meals and vitamins and minerals.

Patients should decrease excess sodium in the diet when edema or fluid retention occurs. Weight should be reduced to within 20% of ideal weight. Regular exercise and stress management techniques.

If the patient is taking oral contraceptives, they should be discontinued.