Premenstrual syndrome

Premenstrual syndrome: Excerpt from Professional Guide to Diseases (Eighth Edition)

Also designated “late luteal phase dysphoric disorder” (LLPD) in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, premenstrual syndrome (PMS) is characterized by varying symptoms that appear 7 to 14 days before menses and usually subside 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.

Causes and incidence

The list of biological theories offered to explain the cause of PMS is impressive. It includes such conditions as a progesterone deficiency in the menstrual cycle’s luteal phase and vitamin deficiencies. Although there’s no evidence that PMS is hormonally mediated, failure to identify a specific disorder with a specific mechanism suggests that PMS represents a variety of manifestations triggered by normal physiologic hormonal changes. Researchers believe that 70% to 90% of women experience PMS at some time during their childbearing years, usually between ages 25 and 45.

Signs and symptoms

Clinical effects 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).

PMS may need to be differentiated from premenstrual dysphoric disorder, which is a more severe form of PMS that’s marked by severe depression, irritability, and tension before menstruation. (See Premenstrual dysphoric disorder.)

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 prior to diagnosis. Estrogen and progesterone blood levels may be evaluated to help rule out hormonal imbalance. A psychological evaluation is also recommended to rule out or detect an underlying psychiatric disorder.

Treatment

Educating and reassuring patients 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 own individual set of symptoms. Treatment may include calcium and magnesium supplementation, vitamins (such as B complex), prostaglandin inhibitors, and nonsteroidal anti-inflammatory drugs. Diuretics may be prescribed for patients who experience significant weight gain due to fluid retention. Psychiatric medications and therapy may be prescribed for women who develop anxiety, irritability, or depression. Hormonal therapy may include a trial on hormonal contraceptives, which may either decrease or increase PMS symptoms. The use of progesterone vaginal suppositories during the second half of the menstrual cycle is still controversial.

For treatment to be effective, the patient may have to maintain a diet that’s low in simple sugars, caffeine, and salt.

Special considerations

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

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

❑ If possible, discuss ways in which the patient can modify her lifestyle, such as making changes in her diet and avoiding stimulants and alcohol.

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

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Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 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: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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