Premenstrual Syndrome (PMS)
This booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.
This is the association of psychological & physical symptoms with the days preceding menstruation. In its severest form, the premenstrual dysphoric disorder consists of a cluster of 7 categories of psychological symptoms. Irritability, anxiety & mood lability are sometimes described as being ‘quicker to anger & quicker to tears’ & cause considerable distress. Physical symptoms include a feeling of heaviness or bloating & breast engorgement & tenderness.
Diagnosis
The pattern must be cyclical, by definition it is confirmed over 3 cycles (rarely insisted upon) & should not be a misdiagnosed depression which is continuous.
Management
Explanation, the relationship to the hormonal cycle, is essential. Many treatments have been attempted with mixed success. SSRIs remain the cornerstone of the treatment of psychological symptoms. Diuretics may assist with bloating & breast tenderness. NSAIDs may give symptomatic relief. Many vitamin preparations have been used. Avoidance of caffeine & alcohol may be of benefit.