Pre-menstrual Syndrome

Premenstrual syndrome (PMS) is any of a complex of symptoms experienced by some women in the days immediately before menstruation

Aetiology

  • The vast majority of women (95%) get premenstrual symptoms, however to be classed as PMS the symptoms must impact on daily living
  • Four in ten women (40%) experience symptoms of PMS and of these 5–8% suffer from severe PMS

Pathophysiology

  • Not clearly understood
  • Sensitivity to progesterone - serum concentrations of estrogen and progesterone the same in those with and without PMS
  • Serotonin receptors are responsive to estrogen and progesterone, and selective serotonin reuptake inhibitors (SSRIs) are proven to reduce PMS symptoms
  • GABA (γ-aminobutyric acid) levels are modulated by the metabolite of progesterone, allopregnanolone, and in women with PMS the allopregnanolone levels appear to be reduced

Clinical presentation

  • Symptoms must be present in luteal phase, abate during menstruation followed by a symptom free week

Physical symptoms

  • Breast tenderness
  • Bloating
  • Headache
  • Skin disorder
  • Weight gain
  • Swelling
  • Joint pain
  • Fatigue

Psychological symptoms

  • Mood swings
  • Anger
  • Depression
  • Tension
  • Not in control
  • Lack of interest
  • Loneliness
  • Hopelessness
  • Suicidal ideation

Behavioural symptoms

  • Sleep disturbance
  • Change in appetite
  • Restlessness
  • Poor concentration
  • Confusion
  • Social withdrawal

Investigations

  • Record symptoms prospectively, over two cycles using a symptom diary (retrospective recall unreliable)
  • A symptom diary should be completed by the patient prior to commencing treatment
  • Can use GnRH analogues to help if diagnosis from diary no conclusive

Management

notion image