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Premenstrual Symptoms

It is a psychosomatic disorder of unknown etiology, in which there is cyclic appearance of symptoms that regularly occur during luteal phase of each ovulatory cycle.

 

The most common premenstrual symptoms (PMS) are categorized into cluster by Moos:
 

Anxiety:

  • Nervous tension
  • Mood swings
  • Irritability
  • Restlessness

Water retention:

  • Weight gain
  • Swelling
  • Breast tenderness
  • Abdominal bloating

Depression:

  • Crying
  • Confusion
  • Social withdrawal
  • Insomnia

Pain:

  • Cramps
  • Headache
  • Backache
  • Breast pain

Concentration:

  •  Difficulty in concentrating/ confusion

Autonomic reaction:

  •  Dizziness, cold sweats, nausea, and hot flushes

Differential Diagnosis for PMS

 

Common differential diagnosis:

  • Adjustment disorder with depressed mood
  • Affective disorders
  • Anxiety disorder
  • Substance-abuse disorder
  • Personality disorder
  • Dysmenorrhea

Less common differential diagnosis:

  • Psychosis
  • Eating disorder
  • Manic-depression disorder
  • Chronic fatigue syndrome
  • Migraine headaches
  • Irritable bowel syndrome

Treatments of PMS

 

 

 Conservative Measures

 Inhibition of Ovulation

 Medications Directed at Symptoms

Salt/ fluid/ alcohol / caffeine restriction

 Oral contraceptives (especially

 drospirenone containing)

 Fluid retention: diuretics

Counseling, emotional support

 GnRHa

 Pain: PG inhibitors

Low-fat, high-fiber diet and essential fatty acids

 Danazol

 Mastalgia: evening primrose oil

 and pyridoxine

Exercise

 

 Anxiety / depression: SSRI





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