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Essentials of Diagnosis
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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
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General Considerations
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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
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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
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Differential Diagnosis
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Diagnostic Procedures
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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
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FOR MILD TO MODERATE SYMPTOMS
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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
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FOR PHYSICAL SYMPTOMS
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WHEN MOOD DISORDERS PREDOMINATE
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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 ...