[Premenstrual syndrome]

The Premenstrual Syndrome (PMS) is defined as the repeated occurrence of psychic disability accompanied by physical symptoms such as weight-gain, mastodynia and edema during the luteal phase. Irritability, depressive mood, lack of concentration and anxiety are the dominant psychiatric features. These symptoms culminate during the premenstrual period and disappear at the onset of menstrual bleeding. The symptomatology is of variable degree. About 2 to 3% of all women of reproductive age are severely impaired by these symptoms. The etiology of PMS is unknown. Disturbance of serotonin metabolism in the central nervous system is discussed. Furthermore abnormalities of the metabolism of sex-steroids in the brain could be involved, since these metabolites are able to modulate the GABA-ergic system. This applies in particular to progesterone-metabolites. Other etiologic concepts favour the ideas of elevated aldosterone activity, variations of endogenous opiod-levels or transient hyperprolactinemia. Thus the unknown etiology and the complex pathophysiology explain the polypragmatic therapeutic strategies including psychotherapy, treatment with psychopharmacologic agents, administration of aldosterone-antagonists, GnRH-analoga and finally prescription of oral contraceptives. The management of PMS requires individualized care by primarily treating the leading symptoms.