Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 18-08: Premenstrual Syndrome (Premenstrual Tension) + Key Features Download Section PDF Listen +++ +++ Essentials of Diagnosis ++ Recurrent, variable cluster of troublesome physical and emotional symptoms that develops during the 5 days before the onset of menses Symptoms subside within 4 days after menstruation occurs In about 10% of affected women, the syndrome may be severe +++ General Considerations ++ The pathogenesis is still uncertain. Psychosocial factors may play a role Suppression of ovulation with an oral contraceptive is sometimes helpful, but the patient often complains that she still has premenstrual syndrome +++ Demographics ++ Intermittently affects about one-third of all premenopausal women, primarily those 25–40 years of age + Clinical Findings Download Section PDF Listen +++ +++ Symptoms and Signs ++ Women may not experience all the symptoms or signs at one time Bloating Breast pain Headache Swelling Irritability, aggressiveness, depression, inability to concentrate, libido change, lethargy, and food cravings +++ Differential Diagnosis ++ Depression Premenstrual dysphoric disorder Endometriosis Uterine leiomyomas (fibroids) Pregnancy Anxiety disorder Hypothyroidism + Diagnosis Download Section PDF Listen +++ +++ Diagnostic Procedures ++ Careful evaluation of the patient History of symptoms + Treatment Download Section PDF Listen +++ +++ General Measures ++ Current treatment methods are mainly empiric Provide support for the emotional and physical distress Advise the patient to keep a daily diary of all symptoms for 2–3 months to help in evaluating the timing and characteristics of the syndrome If her symptoms occur throughout the month rather than in the 2 weeks before menses, she may have depression or other mental health problems in addition to premenstrual syndrome +++ Specific Measures +++ FOR MILD TO MODERATE SYMPTOMS ++ Aerobic exercise Reduction of caffeine, salt, and alcohol intake Alternative therapies, eg, an increase in dietary calcium (to 1200 mg/day), vitamin D, or magnesium, and complex carbohydrates in the diet, acupuncture, and herbal treatments, may be helpful but remain unproven +++ FOR PHYSICAL SYMPTOMS ++ Drugs that prevent ovulation, such as hormonal contraceptives Combined hormonal contraceptive methods (pill, patch, or vaginal ring) GnRH agonist with "add-back" therapy, such as conjugated equine estrogen, 0.625 mg orally daily with medroxyprogesterone acetate, 2.5–5 mg orally daily) +++ WHEN MOOD DISORDERS PREDOMINATE ++ First-line drug therapy includes serotonergic antidepressants (citalopram, escitalopram, fluoxetine, sertraline, venlafaxine) Several serotonin reuptake inhibitors (such as fluoxetine, 20 mg orally, either daily or only on symptom days) have been shown to be effective in relieving tension, irritability, and dysphoria with few side effects There is little data to support the use of calcium, vitamin D, and vitamin B6 supplementation There is insufficient evidence to support cognitive behavior therapy + Outcome Download Section PDF Listen +++ +++ Prognosis ++ Symptom-specific therapy is usually helpful in ameliorating symptoms + References Download Section PDF Listen +++ + +Green-top Guideline No. 48. Management of premenstrual syndrome. BJOG. 2017 Feb;124(3):e73–105. [PubMed: 27900828] + +Naheed B et al. Non-contraceptive oestrogen-containing preparations for controlling symptoms of premenstrual syndrome. Cochrane Database Syst Rev. 2017 Mar 3;3:CD010503. [PubMed: 28257559] + +Yonkers KA et al. Premenstrual disorders. Am J Obstet Gynecol. 2018 Jan;218(1):68–74. [PubMed: 28571724]