Premenstrual syndrome (PMS)

Description

Premenstrual syndrome is a constellation of symptoms that occurs prior to menstruation and is severe enough to interfere significantly with the patient's life. DSM-IV-R diagnosis is premenstrual dysmorphic disorder when the dominant symptoms are emotional.

System(s) affected: Endocrine/Metabolic, Reproductive, Nervous

Genetics: Unknown, probably familial incidence

Incidence/Prevalence in USA: Almost all women have some symptoms prior to menses (this is not PMS). About 5% have actual PMS.

Predominant age: Childbearing years, increasing with years

Predominant sex: Females only

Sings and symptoms

Symptoms can involve any organ system but the following are more common:

• Depressed mood
• Mood swings
• Irritability
• Difficulty concentrating
• Fatigue
• Edema
• Breast tenderness
• Headaches
• Sleep disturbances

Causes:

Unknown, presumed hormonal; perhaps interacting with neurotransmitters

Risk Factors

• Premenstrual exacerbations can occur with other diseases (i.e., depression)
• Caffeine and high fluid intake exacerbate PMS symptoms
• Stress may precipitate
• PMS increases with age
• History of depression
• Tobacco use

Diagnosis

Diagnosis

The major differentials are psychiatric syndromes, particularly depressive disorders and/or dysthymia. Other entities may be suggested by history or physical.

Laboratory

There are no laboratory tests which confirm or refute PMS. History and physical may disclose a need for specific laboratory tests.

Drugs that may alter lab results: N/A

Disorders that may alter lab results: N/A

Diagnostic Procedures

Patients complete questionnaires over a minimum of two months to confirm premenstrual exacerbation of symptoms and lack of substantial symptoms in the follicular phase

Treatment

APPROPRIATE HEALTH CARE

Outpatient

General Measure