ABSTRACT
The clinical approach to evaluation and management of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) involves taking an accurate history, prospective daily symptom monitoring to establish the diagnosis, patient-specific initial medical or psychological therapy, and adequate follow-up with appropriate alterations in the treatment plan. A typical patient can present with premenstrual irritability, mood swings, anxiety and/or depression, and physical symptoms that may include breast tenderness, bloating, fatigue, appetite, and sleep alterations, or difficulty concentrating; these conditions result in significant overall interference with daily activities or social interactions. As the symptoms are not unique in their nature but only in their timing, the diagnosis should be made only after the patient completes daily recording of bothersome symptoms for 2-3 consecutive months. However, a detailed psychiatric interview by an appropriately trained professional may rule out underlying affective disorder. This may be a useful compromise when only retrospective information is available.1 Various medical and affective disorders included in the differential diagnosis must be excluded. Current management strategies include education and self-care, calcium supplementation, and the choice of a number of psychotropic agents that augment serotonin, administered either throughout the cycle or during the luteal phase alone. Pharmacological options include selective serotonin reuptake inhibitors (SSRIs), serotonin/norepinephrine reuptake inhibitors (SNRIs), serotonergic tricyclic antidepressants, or hormonal approaches that prevent ovulation, such as some oral contraceptives, gonadotropin-releasing hormone agonists (GnRH agonists), danazol, and highdose estrogen. Psychological approaches, including cognitive/behavioral and relaxation therapy, may also
be effective. The treatment plan should be designed according to the patient’s specific symptoms, past pharmacological treatment experiences, and other current and past health and contraceptive needs.
