Premenstrual syndrome and premenstrual dysphoric disorder. II. Diagnosis and treatment

Abstract

Premenstrual syndrome (PMS) is one of the most common problems for women of reproductive age. The physical, mental and behavioural symptoms recur during the luteal phase of the cycle in daily life and cause a deterioration in the quality of life, affecting the patient's social, work and family relationships. Symptoms typically disappear sponta¬neously within a few days after the onset of menstruation. The onset and severity of PMS are determined by the cycli¬cal functioning of the hypothalamic-pituitary-ovarian axis and the combined presence of other physiological (e.g., chronobiological and circadian) and psychological stressors, which interact with each other. The diagnosis of PMS and premenstrual dysphoric disorder (PMDD) is based on the following criteria, as recommended by the Interna¬tional Society for Premenstrual Disorders (ISPMD): in PMS, the woman has 1-4 symptoms, which may be physical, behavioural or affective/psychological, or at least five symptoms, which may be physical or behavioural. However, if a woman has 5 or more symptoms, and one of these is affective (e.g., irritability, mood swings, anger) in addition to physical or behavioural symptoms, a more accurate diagnosis of PMDD can be made. Since, in addition to the gen¬eral and gynecological history, the prospective scales (e.g., Prospective record of the impact and severity of menstrual symptoms - PRISM; Daily record of severity of problems - DRSP) completed daily by the physician are helpful in confirming the diagnosis of PMS and PMDD, it is important to take into account the severity of symptoms, the woman's plans for conception or contraceptive needs, her other associated medical conditions, her response to previ¬ous treatment methods, and her history of other medical conditions when formulating a treatment plan. Therapeutic options include regular aerobic exercise, stress relief, cognitive behavioural therapy, drug treatments (selective sero¬tonin reuptake inhibitors - SSRIs, combined oral estrogen-progestin contraceptives - COCs, GnRH agonists), depending on the severity of PMS and PMDD.