272 Obstetrics and Gynecology Board Review •••
❍ What is the term for the cyclic appearance of a large constellation of symptoms (over 100) just prior to
menses followed by a period of time entirely free of symptoms?
Premenstrual syndrome or PMS.
❍ Name the most common symptoms of PMS.
Bloating, anxiety or tension, breast tenderness, depression, fatigue, irritability, and appetite changes.
❍ How is the diagnosis of PMS made?
It is a clinical diagnosis, often based on a cycle diary. However, the National Institute of Mental Health has
suggested that PMS requires documentation of at least a 30% increase in the severity of symptoms in the 5 days
prior to menses and a symptom-free period starting sometime during the menses.
❍ What percentage of women suffer from PMS?
It is actually difficult to ascertain, but up to 80% of women develop emotional and physical changes related to
their cycles during the reproductive years.
❍ How is the cognitive function of women with PMS changed during the luteal phase?
Despite feelings of inadequacy, women with PMS show no deficit in memory, attention, or concentration.
❍ Name six nonpharmacologic treatments that should be initial treatment of PMS.
Elimination of caffeine.
Smoking cessation.
Regular exercise.
Adequate sleep.
Decrease stress.
Regular nutritious diet.
❍ What dietary supplement has been associated with 48% reduction in symptom scores?
Calcium (1200 mg daily).
❍ Name the differential diagnosis of premenstrual dysphoric disorder (PMDD).
Underlying psychiatric disorder, thyroid abnormalities, migraine, diabetes, asthma, epilepsy, irritable bowel
syndrome, and autoimmune disorders.
❍ What is PMDD?
PMDD is considered a psychiatric disorder where women predominantly have emotional symptoms that are
serious enough to disrupt their personal relationships and interfere with their daily lives.
❍ How can PMS be distinguished from PMMD?
PMS typically requires that women experience both physical and emotional symptoms, while PMMD can be
purely emotional/behavioral. PMMD is more severe and tends to have predominance of anger, irritability, and
internal tension.