Premenstrual syndrome: approaches to diagnosis and treatment

There has been much confusion in the literature over the definition, diagnosis and treatment of premenstrual syndrome (PMS). This article discusses definitions of PMS, incidence, etiology and symptomatology. Diagnosis depends on the timing of symptoms rather than the type. Symptoms commonly occur during the late premenstruum; at ovulation and during the premenstruum; or at ovulation, gradually increasing in severity throughout the luteal phase. To diagnose PMS, three consecutive menstrual cycles must be charted, the symptoms must be limited to the luteal phase, and there must be a complete absence of symptoms for at least one week in the postmenstruum. Rational treatment programs for mild, moderate and severe PMS are proposed. The role of progesterone in treatment is discussed.