Premenstrual Syndrome

• Recurring cyclical disorder in the luteal phase of the menstrual cycle
• Involves behavioural, psychological and physical changes resulting in the loss of work or social impairment
• Prevalence has been reported as being 90%
• Aetiology unknown but an ovarian cycle is a prerequisite
• Symptoms are varied and non-specific
• Psychological include
  • Irritability
  • Depression
  • Tension
  • Mood swings
  • Anxiety
• Somatic symptoms include
  • Weight gain
  • Bloating
  • Mastalgia
  • Headache
  • Backache
• Symptoms can occur without menstrual bleeding i.e. after a hysterectomy with ovarian conservation

 

Diagnosis

• Diagnosis of exclusion
• Symptoms must be present for 4 months out of the last 6
• Symptoms must be cyclical
• GnRH analogues can be used as a diagnostic tool

 

Treatment

• Advice regarding diet and exercise
• Reassurance
• Dietary supplements
• Vitamin B6
• Evening primrose oil
• Combined oral contraceptive pill
• GnRH analogues (short term)
• SSRI’s
• Oophorectomy when patient is unresponsive to therapy