Premenstrual syndrome. Tactics for intervention

Premenstrual syndrome (PMS) is a very common disorder. It is diagnosed by excluding other disorders, including psychopathology, and with use of a menstrual diary. Although the cause of PMS remains unknown, treatment is usually effective. For the majority of patients, reassurance, dietary changes, and regular exercise are all that is necessary. If this is ineffective, vitamin B6 and, if indicated, vitamin E or zinc sulfate should be added to the regimen. If therapy still is not effective, a diuretic (preferably spironolactone [Aldactone]) or natural progesterone should be added. This may also be done during the three to six months required for dietary therapy to achieve maximum effectiveness. Diuretics are less expensive, easier to use, and easier to obtain than natural progesterone, which is not widely available. If oral contraceptives are desirable for the patient, progestin-dominant pills may be tried instead of a diuretic or natural progesterone. For those patients whose symptoms are resistant to all of the aforementioned therapy, bromocriptine (Parlodel) or danazol (Danocrine) can be added to the regimen; these drugs, however, should be prescribed only by practitioners experienced in their use.