Review Question - QID 105172

Premenstrual syndrome (PMS) is a constellation of physical and affective symptoms associated with the luteal phase of the female reproductive cycle that remit with the onset of menses or shortly thereafter. Cold intolerance is not a component of the syndrome and would be more consistent with hypothyroidism.

PMS is diagnosed based on history and ruling out overlapping conditions such as anemia, endocrine abnormalities, and other psychiatric conditions. Some of the symptoms of PMS include: depression, anxiety, anhedonia, fatigue, headaches, bloating, and weight gain. The symptoms are severe enough to interfere with functioning in social or professional settings. The symptoms resolve for at least 1 week during each menstrual cycle.

Biggs and Demuth report that PMS affects 20-32% of premenopausal women. Proposed etiologies include increased sensitivity to normal cycling levels of estrogen and progesterone, increased aldosterone and plasma renin activity, and neurotransmitter abnormalities, particularly serotonin.

Vleck and Safranek discuss the pharmacological therapies available for PMS. Based on randomized controlled trials (RCTs), vitamin B6 and elemental calcium have been shown to be effective, safe, and inexpensive. SSRIs may be more effective, but are also more expensive and may result in adverse side effects. Convincing evidence is lacking for oral contraceptives, diuretics, magnesium, beta blockers, and lithium.

Illustration A shows an example of a symptom calendar, a tool often used by physicians to help patients track their symptoms prospectively and assess correlation with the menstrual cycle.

Incorrect Answers:
Answers 1, 2, 4, and 5: These symptoms are not consistent with PMS.