Recognition and treatment of premenstrual syndrome

Premenstrual syndrome (PMS) is the title applied to a broad range of physical and psychological symptoms that occur cyclically, usually seven to 14 days prior to the onset of a woman's menstruation, and disappear during menstruation. Although the symptoms of premenstrual syndrome were described more than 50 years ago, recognition of PMS by the medical establishment as a discrete condition, which requires attention and treatment, is a fairly recent development. It is estimated that 30 percent of women experience PMS in a debilitating form at some point in their lifetimes from menarche to menopause. The symptomatology of PMS is varied; it includes such psychological symptoms as irritability, depression, oversensitivity, mood swings and anxiety, in addition to such physical symptoms as water retention, breast tenderness, weight gain and migraines. This broad range of symptoms has increased the difficulty of establishing an etiology for the syndrome, and it is now suggested that there may be several processes at work, each responsible for a different aspect of PMS. Care of the PMS patient by nurse practitioners initially requires acknowledgment of the legitimacy of her condition. A detailed physical examination should be accompanied by careful interviewing to elicit the most complete picture of the patient's experience with PMS. Treatment, which can involve dietary changes, hormone or antigonadotropin administration, must be individualized according to a patient's initial symptomatology and subsequent response. At present, research is in progress which will enhance our understanding and ability to deal with PMS.