Premenstrual Syndrome

Published on 06/06/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 06/06/2015

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Chapter 41 Premenstrual Syndrome

INTRODUCTION

Description: Premenstrual syndrome (PMS) involves physical and emotional symptoms characterized by their relationship to menses. Symptoms are confined to a period of not more than 14 days before the onset of menstrual flow with complete resolution at, or soon after, the end of menstrual flow.
Prevalence: Reproductive (25% to 85%; 5% to 10% affect lifestyle, 2% to 5% meet strict criteria).
Predominant Age: Reproductive; most commonly 30s and 40s.
Genetics: Family tendency, but no confirmed genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: The physiologic foundations of PMS, premenstrual dysphoric disorder (PMDD), and premenstrual magnification (PMM) have yet to be established. The most promising research into a cause of PMS has been in the areas of β-endorphins and serotonin.
Risk Factors: None known.

CLINICAL CHARACTERISTICS

Signs and Symptoms

Physical or emotional symptoms confined to a period of not more than 14 days before the onset of menstrual flow with complete resolution at, or soon after, the end of menstrual flow. More than 150 different signs and symptoms have been described under the rubric of PMS. (The character of the symptoms is not important—only the timing of their appearance. Symptoms that are present at all times but worsen before menses or those that appear at irregular intervals do not meet the criteria for PMS; they should be classified as premenstrual magnification.)

DIAGNOSTIC APPROACH

Differential Diagnosis

• Breast disorders
• Chronic fatigue states
• Drug and substance abuse
• Endocrinologic disorders
• Family, marital, and social stress
• Gastrointestinal conditions
• Gynecologic disorders
• Idiopathic edema
• Psychiatric and psychologic disorders

Associated Conditions: Bipolar disorders, sleep disorders, chronic pain states, and somatization.

Workup and Evaluation

Laboratory: Complete blood count, liver enzyme studies, endocrine studies (androgens, follicle-stimulating hormone [FSH]/luteinizing hormone [LH], glucose tolerance test, prolactin, thyroid function studies [highly sensitive thyroid-stimulating hormone, thyronine, thyrotropin-releasing hormone stimulation]), all to rule out other conditions.
Imaging: No imaging indicated.
Special Tests: Prospective menstrual calendar or other diary for a 3-month period to establish the diagnosis.
Diagnostic Procedures:

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