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.
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.
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
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.
Special Tests: Prospective menstrual calendar or other diary for a 3-month period to establish the diagnosis.
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