Clinical Information on Premenstrual Syndrome

Basic information Premenstrual Syndrome

Genes of relapsing mental and / or somatic character which occurs in the post-ovulatory (luteal) phase of the menstrual cycle 1
The genes disappear during the first days of menstruation
Premenstrual symptoms occur in a mild form in 75% of all women
By premenstrual syndrome (PMS) symptoms of a difficulty level so they affect the woman’s daily functioning
Severe symptoms of domination of dysphoria is called in English præmenstrual dysphoric disorder (PMDD)

75% of all women have shorter or longer periods of physical or psychological reactions in the luteal phase
3-10% have PMS, i.e. Symptoms of a difficulty level, which affect the daily functioning
In ca. half of these cases are the psychological symptoms prominent
The symptoms can be seen throughout the fertile period but usually start in 20-35 years of age, and is most prominent in women between 30 and 40 years 2

The etiology is not clear, but progesterone plays a central role in the pathogenesis
There are normal hormone concentrations, but presumably an altered sensitivity to progesterone
A progesterone triggered inhibition of neurotransmitters in the CNS (serotonin and GABA-dependent systems 3 ) may contribute to the psychological symptoms
There may be fluid retention and changes in the gastrointestinal tract motility – perhaps secondary to relative calcium deficiency
PMS occurs only in ovulatory cycles
Cultural and personal circumstances play probably a role in the symptoms of the nature and severity

Symptoms debuts after ovulation and disappear during – or shortly after – menstruation
There a symptom-free interval until the next menstruation
The symptoms must be repeated for several cycles

Irritability, aggression, mood swings, depressed mood, anxiety, crying trend, concentration problems

Reference is rare required
At very serious genes can be “pharmacological ovariectomy” is attempted in gynecologist

Cyclic genes is a natural part of the women’s menstrual cycle
There are different views of PMS – varying from the symptoms have a healthy sign and a sign of the proper functioning of ovulations, and it is natural to live out their attacks – for a pathophysiological abnormal condition that requires medical treatment
The doctor’s role is to avoid medicalisation of healthy women, and help those who need
Treatment should only be started after the diagnosis of PMS or PMDD is asked
Non-pharmacological treatment is generally the first choice
- Physical exercise
- Stress-reducing techniques
- Possibly. cognitive psychotherapy
- A significant number of nonpharmacological treatments are tried, but few are effectively documented
Pharmacological treatment with proven efficacy
SSRI
Alprazolam
GnRH agonists
Pharmacological treatment with possible effect
- Oral contraceptives
  - either with a drospirenonholdigt composition
  - and / or as a continuous treatment without a break – or break every 3 months
- spironolactone

What can the patient do?

Accept that cyclic symptoms is a normal response to the differing hormone levels during the menstrual cycle
There are many “folk remedy” for increased exercise, coffee, B-vitamin supplements, dietary supplements and herbal remedies
Studies that document the efficacy of lifestyle changes and natural products lacking

Oral contraceptives
- Oral contraceptives with drospirenone with documented effect on the genes dysphoric
- Continuous treatment (gapless) with other monophasic pill has an effect on mastalgia, bloating, pelvic pain and in some degree of mood swings
Continuous processing by monophasic oral contraceptives containing drospirenone, would be a possible choice 4
SSRI – in severe PMS and the predominantly psychological symptoms 5 . You should be aware of side effects of SSRI treatment like nausea (NNH = 7), decreased energy (NNH = 9), somnolence (NNH = 13) and fatigue (NNH = 14) and sweating (NNH = 14)
- Paroxetine or citalopram 10-20 mg daily
  - The dose can be increased if necessary
  - The treatment is given continuously or only during the luteal phase
  - Anxiolytics, which does not affect the SSRI system has no effect
diuretics
- Spironolactone 25-100 mg x 1 DGL in the last 14 days of the cycle,

There are large individual variations in the duration, severity and type of the symptoms
In menopause disappear premenstrual genes

Usually no complications
Changing relationships to the environment and the immediate family when the condition involves severe irritability and behavior change