Premenstrual Syndrome (PMS): A Guide to Understanding and Managing

PMS, or Premenstrual Syndrome, affects more than one-third of women, seriously impacting their quality of life. The Royal College of Obstetricians and Gynaecologists in the UK updated its guidelines in 2017 to tackle issues related to the misdiagnosis of PMS and the use of ineffective treatments. These guidelines provide a framework to recognize, diagnose, classify, and manage PMS.

Definition: PMS refers to physical and psychological symptoms occurring in the luteal phase of the menstrual cycle, ceasing with menstruation, followed by a symptom-free week. It’s defined by timing and the extent to which daily activities are affected. PMS only occurs in menstruating women and not before menarche, after menopause, or during pregnancy.

Prevalence: Around 40% of menstruating women experience PMS symptoms, with 5-8% suffering from severe PMS that significantly affects their lives.

Causes: Two main theories surround PMS causes: sensitivity to progesterone or neurotransmitter interactions involving serotonin and gamma amino-butyric acid (GABA).

Symptoms: PMS involves a range of psychological and physical symptoms, including mood swings, depression, fatigue, irritability, pain, bloating, and more. Symptoms may vary in severity and duration.

Diagnosis: Recording symptoms over two to three cycles using a symptom diary is crucial. A reliable questionnaire diary, such as the Daily Record of Severity of Problems form, simplifies this process. If inconclusive, gonadotrophin-releasing hormone (GnRH) analogues may be used to see if suppressing the menstrual cycle alleviates symptoms.

Criteria for Diagnosing Core Premenstrual Disorder:

  • Precipitated by ovulation
  • Any number of symptoms
  • Symptoms recur in the luteal phase
  • Symptoms disappear by menstruation
  • A symptom-free week occurs between menstruation and ovulation
  • Symptoms must be prospectively rated
  • Not an exacerbation of an underlying disorder
  • Significant distress and impairment of daily activities

Treatment: Treatment for PMS follows a progressive approach:

First-line options include cognitive-behavioural therapy, exercise, dietary supplements, and low-dose SSRIs.

Second-line treatments involve hormonal options like oestradiol patches and higher-dose SSRIs.

Third-line includes GnRH analogues with add-back hormone therapy.

Fourth-line involves surgical treatment, like a hysterectomy with bilateral salpingo-oophorectomy.

For severe PMS, consider referral to a gynaecologist or endocrinologist. A multidisciplinary team, including a GP, gynaecologist, mental health professional, and dietician, may be necessary for comprehensive care.

PMS is a common condition that affects women, and its diagnosis and management have evolved to improve the quality of life for those who suffer from it. Timely and appropriate treatment can make a significant difference in the lives of affected individuals.