Premenstrual syndrome

Premenstrual syndrome: Excerpt from Handbook of Diseases

Characterized by varying symptoms, premenstrual syndrome (PMS) appears 7 to 14 days before menses and usually subsides with its onset. The effects of PMS range from minimal discomfort to severe, disruptive symptoms and can include nervousness, irritability, depression, and multiple somatic complaints.

Researchers believe that 70% to 90% of women experience PMS at some time during their childbearing years, usually between ages 25 and 45.

Causes

The biological theories offered to explain the cause of PMS include such conditions as a progesterone deficiency in the luteal phase of the menstrual cycle and vitamin deficiencies. Many have been discredited.

Failure to identify a specific disorder with a specific mechanism suggests that PMS represents various manifestations triggered by normal physiologic hormonal changes.

Signs and symptoms

Clinical features vary widely among patients and may include any combination of the following:

❑ behavioral — mild to severe personality changes, nervousness, hostility, irritability, agitation, sleep disturbances, fatigue, lethargy, and depression

❑ somatic — breast tenderness or swelling, abdominal tenderness or bloating, joint pain, headache, edema, diarrhea or constipation, and exacerbations of skin problems (such as acne or rashes), respiratory problems (such as asthma), or neurologic problems (such as seizures).

Diagnosis

The patient history shows typical symptoms related to the menstrual cycle. To help ensure an accurate history, the patient may be asked to record menstrual symptoms and body temperature on a calendar for 2 to 3 months before diagnosis.

Estrogen and progesterone blood levels aren’t clinically useful. A psychological evaluation is recommended to rule out or detect an underlying psychiatric disorder.

Treatment

Education and reassurance that PMS is a real physiologic syndrome are important parts of treatment. Because treatment is predominantly symptomatic, each patient must learn to cope with her specific symptoms.

Treatment may include antidepressants (particularly a selective serotonin reuptake inhibitor), prostaglandin inhibitors, and nonsteroidal anti-inflammatory drugs. For effective treatment, the patient may have to maintain a diet that’s low in simple sugars, caffeine, alcohol, and salt.

Special considerations

❑ Inform the patient that self-help groups exist for women with PMS; if appropriate, help her contact such a group.

❑ Obtain a complete patient history to help identify any emotional problems that may contribute to PMS. If necessary, refer the patient for psychological counseling.

❑ If possible, discuss ways in which the patient can modify her lifestyle, such as making changes in her diet and avoiding stimulants and alcohol. Tell her to keep a diary of her symptoms and menstrual cycle.

CLINICAL TIP: Suggest that the patient seek further medical consultation if symptoms are severe and interfere with her normal lifestyle.

Book Source Details

• Book Title: Handbook of Diseases
• Author(s): Springhouse
• Year of Publication: 2003
• Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5

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