Premenstrual syndrome (PMS) refers to physical and emotional symptoms that occur in the 1-2 weeks before a woman’s period.

• Linked to the luteal phase

Clinical features

More than 200 different symptoms have been associated with PMS

Common emotional and non-specific symptoms:

• Stress, anxiety, difficulty with sleep, headache, malaise, mood swings, increased emotional sensitivity, and changes in libido

Common physical symptoms:

• Bloating, lower back pain, abdominal cramps, constipation/diarrhoea, swelling/tenderness in the breasts, cyclic acne, and joint/muscle pain, and food cravings

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Diagnosis

No laboratory tests or unique physical findings to verify the diagnosis of PMS

Clinical diagnosis

3 key features:

• Chief complaint is ≥ 1 of the emotional symptoms associated with PMS (most typically irritability, tension, or unhappiness).
  • The woman does not have PMS if she only has physical symptoms, such as cramps or bloating.
• Symptoms appear predictably during the luteal (premenstrual) phase, reduce or disappear predictably shortly before or during menstruation, and remain absent during the follicular (preovulatory) phase.
• Symptoms are severe enough to interfere with everyday life

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Management

Mild PMS:

• Lifestyle changes (reducing salt, caffeine, and exercise)
• Nutritional supplementation (calcium and vitamin D)

Physical symptoms:

• Anti-inflammatories (naproxen)

Severe PMS:

• Hormonal contraception:
  • Combined oral contraceptive pill
  • Contraceptive patch
• Antidepressants:
  • SSRIs (fluoxetine, sertraline)