gynecology and obstetrics
Premenstrual Syndrome (PMS)
Key Points
Symptoms of premenstrual syndrome (PMS) can be nonspecific and vary from woman to woman. Diagnose PMS based on symptoms alone. If symptoms seem severe and disabling, consider premenstrual dysphoric disorder (PMDD), which is often underdiagnosed, and ask patients to record symptoms for ≥ 2 cycles; for a diagnosis of PMDD, clinical criteria must be met. Usually, treatment is a matter of trying various strategies to identify what helps a particular patient; start with lifestyle modifications, then SSRIs, oral contraceptives, or sometimes cognitive-behavioral therapy. GnRH agonists and oophorectomy are reserved for severe cases. 