PREMENSTRUAL DISORDERS

PREMENSTRUAL SYNDROME

A   36-year-old patient complains   of  depression, anxiety,    irritability,   and

breast  tenderness, which   occur   on  a   monthly basis.  On  further questioning,

the symptoms    most    commonly    occur   two weeks   before  her menstruation

and disappear   with    menses.

Premenstrual syndrome (PMS) (5% of adult women) includes a wide range of
physical and emotional difficulties, as well as the more severe affective changes
included in premenstrual dysphoric disorder (PMDD). The basis for diagnosis is
a symptom diary that the patient keeps throughout three menstrual cycles. The
specific symptoms are less important than their temporal relationship to the
menstrual cycle. All of the following must be present:

Must    be  recurrent   in  at  least   three   consecutive cycles

Must    be  absent  in  the preovulatory    phase   of  the menstrual   cycle

Must    be  present in  the two postovulatory   weeks

Must    interfere   with    normal  functioning

Must    resolve with    onset   of  menses