ABSTRACT
A 22-year-old female patient sees you in your surgery. You scan her notes and see that she saw one of your colleagues 6 months ago for ongoing problems with stress and irritability. Her symptoms would typically begin 2 weeks prior to her menstruation and ease considerably with the onset of bleeding. She would be ‘a diff erent person’ for the next 2 weeks until the ‘2 weeks from hell’ would begin again. She reported headaches, breast swelling and discomfort, mood swings, inability to concentrate and feeling excessively tired. Th e severity of her symptoms would leave her tearful at times and prone to bursts of anger, the recipient of which would be her poor boyfriend. Your colleague, aft er ascertaining that there were no contraindications, started her on a combined oral contraceptive pill (COCP). He recommended a 6-monthly review and asked her to complete the Daily Record of Severity of Problems, a questionnaire logging her symptoms, for months 1-2 and 5-6 of her treatment. She presents today and bursts into tears, saying that her relationship is on the brink of breakdown due to her symptoms. You look at her completed questionnaire and note that her scores are very high for the latter part of the cycle.
