Premenstrual syndrome (PMS)

Abstract

Premenstrual syndrome (PMS)was first recognized by RT Frank in 1931. However, it was not until 1983 that PMS diagnostic criteria was rather clearly established by The
American Psychiatric Association (APA). Various aetiologies have been proposed and
recently many studies suggest a deficiency of serotonin in the central serotonergic system. Diagnosis of PMS must be made by prospective recording ol the luteal phase related symptoms. Other medical and psychological disorders should be excluded and managed accordingly. Patients with predominantly specific physical symptoms may be treated with specific therapy. Pain-related symptoms should be treated with prostaglandin synthetase inhibitors. Mastalgia may be treated with bromocriptine and significantly weight gain in luteal phase with spironolactone. Psychotropic drugs, especially fluoxetine or alprazolam, may be the first line treatment of severe PMS because of ease of administration and tolerability. Ovulation suppression agents should be preserved for patients who cannot tolerate or do not respond to psychotropic agents. GnRHa with estrogen and progestin add-back may be a good ehoice for this purpose.