Premenstrual Syndrome

This are the psychological, emotional and psychical symptoms occuring during the luteal phase of the menstrual cycle, causing distress/disruption to the patient. It can easily be misdiagnosed as physiological premenstrual symptoms, which most women experience (80-90%). It’s only when it significantly impairs the women that it can be classed as PMS. Therefore, in the history, it's important to find out the severity of symptoms, and the impact they have on the woman’s functioning and quality of life.

Symptoms present right before the period, and resolves once menstruation starts. They aren’t present before menarche, during pregnancy, or after menopause (important to find this out information during a history).

PMS can also occur in response to COCP or HRT, as they contain progesterone, in which it's then called Progesterone-Induced Premenstrual Disorder.

Presentation

• Psychological - Low mood, Anxiety, Mood swings, Irritability, Reduced libido

• Physical – Breast pain, Bloating, Fatigue, Headaches

• Behavioural – Cognitive impairment

Management

Lifestyle - Diet, exercise, vit b supplementation, stress reduction

The 1st line medical option is a new-generation COCP, which contains Oestrogen + Drospirenone i.e. Yasmin.

• This is usually given with a shorter break or no pill-free period as some suffer progestogenic side-effects during the pill-free period