Premenstrual syndrome

Premenstrual syndrome (PMS) is a serious condition that is still poorly understood and accepted. It is a psychological and somatic disorder of unknown aetiology. It is quoted that 95% of women suffer from premenstrual symptoms and 5% of these suffer from PMS. Symptoms of PMS must arise in the luteal phase of a woman’s cycle, be relieved by menstruation, and be recurrent and severe enough to have a major impact on normal functioning. There are no tests to diagnose PMS; instead, a careful history must be taken, ruling out differentials. However, the diagnosis should be made following prospective symptom rating using validated tools. Several treatment options have been suggested for PMS, including behavioural therapies, committing to a regular exercise programme, simple dietary alterations, and pharmacological and surgical interventions. However, the most effective treatments tend to fall into one of two categories: suppressing ovulation or correcting a speculated neuroendocrine anomaly.     

Premenstrual syndrome

Premenstrual syndrome (PMS) is a condition characterized by a combination of psychological and physical symptoms that begin during the luteal phase of the menstrual cycle, cease by the end of menstruation, with a symptom-free period till ovulation. A thorough history, along with other assessment tools, both in primary care and secondary care, is key in identifying and classifying the severity of the symptoms, which can range from mild to very severe. Symptoms can significantly affect a woman's quality of life and with up to 8% of women debilitated by severe PMS, it is vital that they are appropriately identified using investigations available and managed accordingly. Treatment can range from complementary therapies to hormonal and non-hormonal medication, to even surgery, and is introduced in a step-wise manner, often involving a multidisciplinary team. This review outlines the theories of the pathophysiology surrounding the condition, the classification of the disease, key investigations and management options advised in guidelines and research.     

Premenstrual syndrome

Premenstrual syndrome (PMS) affects the quality of life of millions of women. The complexity and variety of clinical presentation together with the cyclic recurrence of affective and somatic symptoms increase the difficulty in understanding and treating the disease. The precise pathophysiology of PMS is still unknown, but it is increasingly believed that, in women with PMS, the sensitive equilibrium between sex-steroids and central neurotransmitters is altered. Several studies have been carried out to understand the origin of the syndrome and to discover new ways of treatment. This review summarizes the most accepted PMS theories and treatments currently available based on the results of the best-designed trials.     

Premenstrual syndrome

Premenstrual syndrome (PMS) is a condition characterized by a combination of psychological and physical symptoms that begin during the luteal phase of the menstrual cycle, cease by the end of menstruation, with a symptom-free period till ovulation. A thorough history, along with other assessment tools, both in primary care and secondary care, is key in identifying and classifying the severity of the symptoms, which can range from mild to very severe. Symptoms can really affect a woman's quality of life and with up to 8% of women debilitated by severe PMS, it is vital that they are appropriately identified using investigations available and managed accordingly. Treatment can range from complementary therapies to hormonal and non-hormonal medication, to even surgery, and is introduced in a step-wise manner, often involving a multidisciplinary team. This review outlines the theories of the pathophysiology surrounding the condition, the classification of the disease, key investigations and management options advised in guidelines and research.     

Premenstrual syndrome

Because researchers are still seeking the cause of PMS, we cannot recommend a single treatment approach that will work satisfactorily with all women who have the syndrome. Investigators have made progress, however, toward defining and diagnosing the condition. We also can help women whose lives are disrupted each month by prescribing specific approaches to symptom management.     

Premenstrual syndrome: a time for introspection

Premenstrual syndrome has emerged as an important reproductive health care issue amid heated debate about whether such a condition, in fact, exists. Polarization of opinion on this issue has been the result of imprecision in the definition of premenstrual syndrome, leading to inappropriate generalization of the disruptive physical, emotional, or behavioral changes of premenstrual syndrome to the entire female population. A shortage of reliable scientific information on premenstrual syndrome has led to inconsistent, and often ineffective, medical intervention by a sometimes skeptical medical profession. Examination of individual biases and the external factors that have influenced our thinking on this issue may allow us to more clearly define our role as a specialty in the ongoing investigations and management of menstrual cycle-related illnesses.     

Premenstrual syndrome as reported by Brazilian women

Objective

To describe the perspectives and attitudes of Brazilian women toward premenstrual syndrome (PMS).

Methods

An exploratory study was conducted in 6 major cities: 1 in each geographic region of Brazil and 1 in the Federal District. Participants were women aged 18-40 years who consulted at public healthcare services or who were members of staff/faculty at university.

Results

Of 1053 women, 96.1% had heard of PMS; 65.4% considered that all or almost all women experienced the condition; 87.5% stated that symptoms occurred prior to menstruation; and 60.3% thought that they had PMS at the time of the interview. The emotional and physical symptoms most frequently mentioned were nervousness/anxiety (76.4%); mood swings/crying (55.7%); pain, swelling, and tenderness of the breasts (37.3%); and cramps (45.4%).

Conclusion

Premenstrual syndrome was reported by a large number of Brazilian women; actions need to be taken to provide more effectively the specific information required by both lay people and healthcare professionals.     

Premenstrual syndrome and associated symptoms in adolescent girls

OBJECTIVE: To investigate the frequency of premenstrual syndrome (PMS) associated symptoms and effects of nutrition on PMS in adolescent girls. PATIENTS AND METHODS: One hundred and seventy-one adolescent girls who had menstrual cycles were included in this study. They were given a questionnaire on criteria for PMS, dysmenorrhea and regularity of menstrual cycle. Modified Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria were used for the diagnosis of PMS. We also investigated which nutritional supplements affect the PMS-associated symptoms and signs. RESULTS: One hundred and five adolescent girls out of 171 (61.4%) met DSM-IV criteria for PMS. There was an association between dysmenorrhea and PMS in 60 (57.1%). Half of the girls, i.e. 52 (49.5%) had mild, 39 (37.1%) had moderate and 14 (13.4%) had severe PMS. The most common symptom of PMS was negative affect particularly in the form of stress (87.6%) and nervousness (87.6%). There was a statistically significant negative relationship between milk consumption and the following: abdominal bloating, cramps, craving for some foods and increased appetite. CONCLUSION: PMS and dysmenorrhea are frequently overlapping. We also found that PMS is associated with dietary habits.     

Premenstrual syndrome: an update for the clinician

Premenstrual syndrome is a complex disorder in which a variety of symptoms can occur in the luteal phase of the menstrual cycle. The symptoms should occur each cycle only from the time near ovulation to soon after the onset of menses. There should be at least 1 week in follicular phase that is symptom-free. Symptoms should be severe enough to significantly interfere with the ability of the patient to function within her normal lifestyle. Diagnosis is based on clinical information from prospective charting of symptoms. Up to 50 per cent of patients who think they have PMS really suffer from another type of mental illness, usually a depressive disorder. Laboratory tests are not generally helpful in the diagnosis. Treatment is based on the type(s) of symptom(s). Available treatments are reviewed with documentation of results from double-blind placebo-controlled experimental designs. The etiology of PMS is not known. However, there are good empiric therapies available that can help most PMS patients.     

Premenstrual syndrome and premenstrual dysphoric disorder in adolescents

PURPOSE OF REVIEW: To review the current knowledge about the prevalence, diagnosis, and management of premenstrual syndromes in adolescents. RECENT FINDINGS: Large epidemiologic studies addressing adolescent premenstrual disorders, clinical presentation, and comorbidity with other disorders have yet to be performed. Randomized controlled treatment trials for teens with moderate-to-severe premenstrual syndrome or the more severe affective predominant, premenstrual dysphoric disorder still are sorely lacking. This review will present an updated review of the published studies with respect to premenstrual syndrome and premenstrual dysphoric disorder in adolescents in the context of the large body of literature regarding presentation, diagnosis, and treatment in adult women. SUMMARY: Premenstrual disorders likely start in the teen years. At least 20% of adolescents may experience moderate-to-severe premenstrual symptoms associated with functional impairment. Current treatment includes lifestyle recommendations and pharmacologic agents that suppress the rise and fall of ovarian steroids or augment serotonin.     

Premenstrual syndrome. Advances in diagnosis and treatment

Premenstrual syndrome and PMDD are increasingly recognized as medical entities that adversely affect the quality of life of a subset of women. When research criteria or the strict definition of PMDD are used, the prevalence of PMS is thought to range from 3% to 5% among reproductive-aged women. Although the precise pathophysiology is not known, it is increasingly believed that women with PMS have an altered sensitivity of central neurotransmitters, particularly serotoninergic, to normal circulating levels of estradiol and progesterone. Significant advances have been made in pharmacologic therapy for PMDD, with the largest clinical trials demonstrating efficacy of the SSRIs. These studies show relief of distressing mood symptoms and improvements in parameters of social function in most patients.