Premenstrual syndrome

1. Premenstrual syndrome Dr Felicia Molokoane

2. introduction • Premenstrual symptoms occur in 95% of all women of reproductive age • PMS occurs in 5% of those women • Terminology for premenstrual disorders has become complex • PMS commonly used • PMT is the lay term • PMDD is the extreme

3. definition • Recurrent psychological or somatic symptoms or both, recurring during luteal phase and resolving by end of menstruation

4. aetiology • Unknown • Seen in women of reproductive age, and is not seen before puberty, during pregnancy or after menopause.

5. diagnosis • For the diagnosis of PMS, the symptoms must • Occur in the luteal phase of the cycle • Resolve by end of menstruation • Be severe enough to have major impact on normal functioning and • Have occurred in at least 4 of the 6 previous cycles

6. The character of the symptoms is less important than their timing and severity

7. management • PMS does not seem to be caused by an endocrine imbalance. • Assessment • History: regularity of menstrual cycle • Physical examination • FBC, U&E, TSH • Record the symptoms for 2 months • Calendar for premenstrual experiences

8. DSM IV CRITERIA FOR PMDD • Prospective documentation of physical and behavioural symptoms being present most of the preceding year • Five or more symptoms must have been present during the week prior to menses • Resolve few days after menses starts

9. DSM IV CRITERIA FOR PMDD • Feeling of sad, hopeless, or self deprecating • Feeling tense, anxious or on edge • Marked lability of mood interspersed with frequent tearfulness • Persistent irritability, anger, and increased interpersonal conflicts • Decreased interest in usual activities • Difficulty concentrating • Feeling fatigue • Marked changes in appetite