Understanding Premenstrual Syndromes

How are premenstrual syndromes (PMS) identified and diagnosed, and what are the best approaches to treatment? PMS is a self-reported condition encompassing a broad array of symptoms which physicians must distinguish from other affective and general medical conditions in women. The hallmark of PMS is the cyclical occurrence of symptoms premenstrually, and their alleviation and remission shortly following the onset of menses. The pathophysiology of PMS involves multiple factors-particularly genetic vulnerability, environmental inputs, and the interaction between gonadal hormone fluctuations and neurotransmitters. For women with very mild symptoms, conservative nonpharmacologic treatment is recommended, including exercise, healthy nutrition, relaxation, and social support. For women with moderate to severe symptoms, especially if these symptoms are mood- and behavior-related, a variety of efficacious treatment options are available, with selective serotonin reuptake inhibitors being the treatment of choice.