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Premenstrual syndrome (PMS) is characterized by recurring physical and emotional symptoms and behavioral changes that occur during the luteal phase of the ovulatory menstrual cycle and disappear within several days of the onset of menstruation. Women with PMS may experience many symptoms (see the box); the most common are bloating, breast tenderness, headache, fatigue, irritability, depression, hostility, and food cravings.
To fulfill diagnostic criteria for PMS the symptoms must not be due to underlying physical diseases (eg, thyroid dysfunction, lupus erythematosus), emotional diseases (eg, bipolar disorder, anxiety disorders, chronic depression), or recurring environmental stress. The symptoms must be severe enough to adversely affect the woman's functional level or sense of well-being. Approximately 5% of women of reproductive age experience premenstrual symptoms severe enough to interfere with normal activities such as
The cause of PMS is unknown. Proposed etiologies include nutritional deficiencies, allergies, hypoglycemia, and hormone excesses or deficiencies. In the past several years, however, there has been increasing evidence that neurotransmitters, such as serotonin, may play a central role in the pathophysiology of some premenstrual symptoms. It is likely that premenstrual symptoms may not be the result of a single biochemical abnormality but may occur in response to biologic, psychologic, and social factors working in premenstrual syndrome, premenstral syndrome, sindrome, PMS, pre menstrual syndrome
Physical, Cognitive, and Emotional Symptoms and Behavioral Changes
in Women with Premenstrual Syndrome
Physical Symptoms Cognitive Symptoms
Bloating Suicidal ideation
Breast tenderness Sensitivity to rejection
Weight gain Decreased concentration
Headache Forgetfulness
Fatigue Feeling overwhelmed
Joint pain Feeling out of control
Constipation Behavioral Changes
Emotional Symptoms Food cravings
Anxiety Social isolation
Irritability Verbally abusive
Sadness Physically abusive
Labile mood Lack of motivation
Anger Overly critical of others
Incoordination
Diagnosis
When PMS coexists with other physical or psychiatric illnesses or exists within a stressful social environment, it may be difficult to determine the contribution of PMS to a patient's symptoms. Therefore, it is important to approach the evaluation of a woman with the complaint of premenstrual symptoms in an
Treatment
Most treatments for PMS are aimed at alleviating symptoms. This can be done primarily with a combination of exercise and medications. Mental health assistance combined with medication may be more helpful than
Women who exercise have milder PMS symptoms. Although dietary changes have been widely recommended, there is no evidence of their effectiveness. The elimination of caffeine and chocolate for those
Diuretics have been used to relieve fluid shifts that may result in soft-tissue swelling. Spironolactone may be useful in treating the physical symptoms of PMS. In cases in which spironolactone does not improve physical symptoms, hydrochlorothiazide may be used for the week preceding menses. Vitamin B6 has been
Studies have shown marked reduction of PMS symptoms in patients receiving the serotonin reuptake inhibitor fluoxetine throughout the menstrual cycle. Other serotonin reuptake inhibitors (eg, sertraline hydrochloride, paroxetine hydrochloride) may also be effective. Alprazolam, a benzodiazepine that acts on
Long-acting GnRH agonists can relieve symptoms of PMS. If symptoms improve with complete ovarian