Volume 2 Issues 10 October, 2021
Premenstrual Syndrome (PMS) is a combination of emotional, behavioral and physical symptoms that occur in the premenstrual or luteal phase of the menstrual cycle. The term “premenstrual tension” appeared in the medical literature 80yrs ago, but widely accepted diagnostic criteria for PMS do not exist. Approximately 80% of women report at least mild symptoms, 20 – 50% report moderate to severe symptoms and about 5% of women report severe symptoms for several says with impairment of role and social functioning. The 5% of women with severest form of PMS generally have symptoms that meet the diagnostic criteria for premenstrual dysphoric disorder (PMDD).
Research criteria for PMDD have been mentioned in DSM‐IV‐TR. Generally recognized syndrome involves mood symptoms (depressed mood, marked anxiety, lability, decreased interest in work, decreased concentration), behavioural symptoms (changes in eating patterns, interpersonal conflicts, lack of energy), and physical symptoms (breast tenderness, edema, headaches). This pattern of symptoms occurs at a specific time during the menstrual cycle, and the symptoms resolve for some period of time between menstrual cycles. These symptoms present in most menstrual cycles during past year, to be confirmed by prospective daily ratings during at least two consecutive symptomatic cycles The hormonal changes occurring during the menstrual cycle are probably involved in producing symptoms, although the exact etiology is unknown. Evaluation includes a full psychiatric evaluation. Medical evaluation should rule out physical conditions that may cause symptoms in association with the premenstrual phase of the menstrual cycle (endometriosis, fibrocystic breast disease, migraine). Use of medications (OTC), caffeine, alcohol, and nicotine should be assessed because these may cause symptoms that mimic PMDD.
Treatment is based on the severity and nature of symptoms. Patients desire to be treated continuously throughout the cycle / only on symptomatic days, and patient’s views regarding the use of psychotropic versus other palliative agents needs to be considered. Mild symptoms can be treated with non‐pharmacological interventions (sleep hygiene, exercise, relaxation, CBT, minimize use of caffeine, salt, alcohol, & nicotine). For those with severe PMDD pharmacological therapy is required. SSRIs (fluoxetine, sertraline, paroxetine, or citalopram) can be administered throughout month / during two premenstrual weeks. Other medications like nortriptyline, nefazodone, & clomipramine have been used. Premenstrual anxiety and irritability may be treated with buspirone & clonazepam. Calcium carbonate, pyridoxine, primrose oil, magnesium, and vitamin E have been used with some results. Other treatment options like progesterone supplementation, synthetic androgen danazol, GnRH agonist leuprolide, are rarely used. Diuretics (spironolactone, hydrochlorothiazide), analgesics (mefenamic acid, naproxen) have been used for symptomatic relief.
Conclusion: women with severe and PMDD comprise a substantial proportion of menstruating women. These women have several symptomatic days each month that lead to disrupted relationships and decreased quality of life. Identification of the disorder and appropriate intervention is of importance to reduce the agony.
Hassan Institute of Medical Sciences
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