Premenstrual syndrome

Question 1

Define premenstrual syndrome.

Answer 1

Premenstrual syndrome (PMS) is characterised by cyclical, physical, and behavioural symptoms occurring in the luteal phase of the normal menstrual cycle.

Question 2

What is the aetiology of premenstrual syndrome? What are risk factors for premenstrual syndrome?

Answer 2

PMS and PMDD occur in women with ovulatory cycles, and they do not occur before puberty or after menopause. This association implies a role of gonadal steroid hormones.

Family history

Mood disorders

Cigarette smoking

White women

Sexual abuse and/or trauma

Question 3

Summarise the epidemiology of premenstrual syndrome.

Answer 3

Clinically significant PMS is thought to affect 3% to 8% of women, with a point prevalence of 20% to 30% in some studies.

Question 4

Where are the signs and symptoms of premenstrual syndrome?

Answer 4

Abdominal bloating

Fatigue

Breast tenderness

Headaches

Depressed mood, irritability, and internal tension

Labile mood

Increased appetite

Forgetfulness and difficulty concentrating

Question 5

What investigations should be performed for premenstrual syndrome?

Answer 5

Symptom diary

Thyroid function tests

Follicle-stimulating hormone levels

Depression screening

Question 6

What is the management of premenstrual syndrome?

Answer 6

Lifestyle modification

Cognitive behavioural therapy (CBT)

Non-steroidal anti-inflammatory drug (NSAID)

Vitamin and mineral supplementation

Combined oral contraceptive (COC)

Question 7

What is the prognosis of premenstrual syndrome?

Answer 7

There are no reports documenting spontaneous remission before the menopause. It is difficult to define spontaneous remission, because women could remit during pregnancy only for symptoms to return subsequent to pregnancy. Women with PMS/PMDD tend to suffer throughout their reproductive life.