Premenstrual syndrome. Current concepts in diagnosis and management

Premenstrual syndrome (PMS), a constellation of physical and psychologic symptoms, is a common complaint among women of reproductive age, particularly women in their 30s or older and among women of greater parity. Symptoms must occur in the luteal phase with resolution or improvement within one or two days of the onset of menses. Numerous hypotheses have been espoused to explain the etiology of PMS, but no definitive cause has been established. The management of PMS may include simple measures such as exercise, dietary changes, and vitamin supplementation. Pharmacologic agents such as progesterone, prostaglandin inhibitors, diuretics, oral contraceptives, or psychotropic drugs may be useful in selected clients. Support and counseling is of paramount importance in the management of PMS. Nurse-midwives can manage women who have minor and transient physiologic and emotional changes associated with mild degrees of PMS. Women with moderate and severe symptoms should be referred for evaluation and follow-up.