Premenstrual syndrome

The term premenstrual syndrome is often used to describe several clinical conditions. Only a full history covering not only reproductive but also psychological and social factors, combined with daily diaries which are kept prospectively for at least two months, can help clarify the problems the patient experiences. As it is the timing rather than the type of symptoms which is essential to a diagnosis, diaries are used to assess symptoms, make a diagnosis and monitor the effectiveness of therapy. Patients with premenstrual syndrome should therefore always keep a diary and bring it to every consultation. We do not know if patients complaining of premenstrual syndrome are at one extreme of a spectrum disorder or if they are a 'specific group'. Such patients may have classical premenstrual syndrome, perimenstrual distress, benign idiopathic oedema, dysmenorrhoea, cyclical benign breast disease or mood symptoms which are not significantly related to the menstrual cycle. There are many aetiological theories--biological, psychological, environmental and social, the syndrome being a complex psychosomatic disorder. For appropriate management an accurate diagnostic formation is required. Reassurance, stress management techniques, an improvement in general mental and physical well-being, information and education are the mainstays of therapy. Symptomatic relief of symptoms is often helpful. Many other managements have been tried with the aim of correcting the underlying aetiological case. These include vitamins, prostaglandin inhibitors and endocrine therapies. As the disorder is long-term, the safety of treatments should be carefully considered.