Pre-Menstrual Syndrome

Definition/diagnostic criteria Pre-menstrual syndrome (PMS) refers to a set of emotional, behavioural, and physical symptoms occurring in the luteal phase of the menstrual cycle, typically resolving with menstruation. The Royal College of Obstetricians and Gynaecologists (RCOG) defines PMS as the recurrence of symptoms that significantly interfere with work or social functioning, occurring during the two weeks before menstruation and improving with or soon after the onset of menstruation. A more severe form, premenstrual dysphoric disorder (PMDD), is characterised by particularly severe psychological symptoms.

Epidemiology PMS affects a significant proportion of women of reproductive age. It is estimated that around 20-30% of women experience moderate to severe symptoms that impact their daily activities, while 5% meet the criteria for PMDD.

Diagnosis

Clinical Features: Symptoms are diverse, ranging from emotional (e.g., irritability, mood swings, anxiety) to physical (e.g., breast tenderness, bloating, headache). The cyclic nature of these symptoms, typically in the luteal phase, is key to diagnosis.

Investigations: Diagnosis is primarily clinical. A symptom diary for at least two menstrual cycles is recommended to confirm the timing and impact of symptoms. There are no specific laboratory tests for PMS, but investigations may be necessary to exclude other conditions.

Treatment Management involves both non-pharmacological and pharmacological approaches:

1. Lifestyle Modifications: Regular exercise, a healthy diet, and cognitive behavioural therapy are recommended. These interventions have shown benefit in reducing PMS symptoms.
2. Pharmacological Treatments:
   • Selective Serotonin Reuptake Inhibitors (SSRIs): First-line for severe PMS or PMDD. They can be taken continuously or only in the luteal phase.
   • Hormonal Contraceptives: Combined oral contraceptives may help some women, but their effectiveness is variable. Continuous use, rather than cyclical, is preferred.
   • Gonadotrophin-Releasing Hormone (GnRH) Analogues: Used in severe cases, sometimes as a diagnostic and therapeutic trial before considering surgery (oophorectomy).
   • Analgesics: For symptomatic relief of physical symptoms like headache and breast pain.
3. Supplements: Calcium and Vitamin B6 supplements may be beneficial, but evidence is limited.

Prognosis PMS generally persists throughout the reproductive years. However, symptoms may fluctuate and change in severity. With appropriate management, most women achieve significant symptom relief. The condition resolves with menopause.