Female Reproductive System ORGAN SYSTEMS

Premenstrual syndrome (PMS)

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


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


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)

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