Premenstrual syndrome: management and pathophysiology

Area of Science:

• Reproductive endocrinology
• Neuropsychiatry

Background:

• Premenstrual syndrome (PMS) is linked to hormonal shifts post-ovulation.
• Symptoms manifest during the luteal phase, without specific hormone level correlations.
• PMS causes significant social and occupational impairment due to affective or somatic symptoms.

Purpose of the Study:

• To review diagnostic and treatment options for premenstrual syndrome.
• To evaluate the efficacy of ovulation suppression and pharmacologic therapies.

Main Methods:

• Review of studies on hormonal events and progesterone metabolites in PMS.
• Analysis of treatments including ovulation suppression (GnRHa, estrogen, oophorectomy) and pharmacologic agents.
• Focus on selective serotonin reuptuptake inhibitors (SSRIs) as a primary treatment.

Main Results:

• Ovulation suppression methods like GnRHa, high-dose estrogen, and oophorectomy show positive evidence but have limitations for conventional use.
• Serotonergic antidepressants, specifically SSRIs, are well-established and highly effective.
• SSRIs represent a first-line pharmacologic therapy for PMS management.

Conclusions:

• While hormonal factors are implicated, specific abnormalities remain unproven.
• Aggressive ovulation suppression methods are not suitable for routine PMS treatment.
• Selective serotonin reuptake inhibitors are the recommended first-line pharmacologic treatment for premenstrual syndrome.