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Treatment guidelines for premenstrual syndrome

Symptoms and diagnosis

  • More than 150 symptoms are reported to be associated with premenstrual syndrome (PMS), the number and type varying from individual to individual. Even within the same person, the severity of symptoms often varies from month to month. Diagnosis depends not on the type of symptom, but on the timing as symptoms usually arise during the luteal phase of the menstrual cycle. Symptoms present 1-14 days before menstruation and disappear at the onset or on the day of the heaviest flow. For the rest of the cycle – usually from the day of heaviest menstrual flow to approximate time of ovulation – the woman feels well. If behavioural symptoms persist throughout the cycle then a psychological or psychiatric disorder must be considered a possibility
  • There are no laboratory tests that make identification simple. Correct diagnosis is a prerequisite for successful therapy, and the best diagnostic tool is the menstrual chart, which provides the precise dates of menstruation and symptoms. The presence of symptoms before and their absence after menstruation are then easily determined. The chart should be maintained for at least two cycles, to demonstrate a pattern clearly. It is worth remembering that cycle lengths vary, with 28 days representing the average. In short cycles, the follicular phase may be only a few days long and symptoms are present for a greater proportion of the time

First steps of management

  • In general, the best treatment for women with PMS is a sympathetic GP and practice nurse, and the most appropriate therapy takes account of the woman's own assessment of the severity of her symptoms. Reassurance that she is not 'going mad' and that PMS affects many women to a greater or lesser extent can be very therapeutic
  • All sufferers benefit from simple advice related to dietary changes, exercise, relaxation, stress avoidance and lifestyle modification
  • The psychotherapeutic effects of discussion, counselling and education cannot be overemphasised

Therapeutic options

  • Due to current lack of understanding of the aetiology of PMS, therapy tends to focus more on the symptoms than the underlying cause. Because the incidence, frequency and severity of symptoms show such wide variation, there may be a considerable range of suitable therapies. It is useful to bear in mind that:
    • if one option has proved ineffective after four cycles, another may prove acceptable
    • certain symptoms respond more favourably to particular therapies
Psychological and behavioural symptoms
Mood swings and depression Tearfulness or feeling 'low'
Tiredness, fatigue or lethargy Tension or unease
Irritability Clumsiness/poor coordination
Difficulty in concentrating Altered interest in sex
Sleep disorders Food cravings
Aggression Loss of self-control
Physical symptoms
Breast tenderness Swollen/bloated feelings
Puffiness of face, abdomen or fingers General aches and pains, especially backache
Headaches Weight gain
Appetite changes Acne or other skin rashes
Constipation or diarrhoea Muscle or joint stiffness
Exacerbation of epilepsy, migraine, asthma, rhinitis or urticaria Abdominal pain/cramps

Treatment guidelines

Treatment guidelines

full guidelines available from…
National Association for Premenstrual Syndrome,
41 Old Road, East Peckham, Kent TN12 5AP (☎ – 0844 815 7311) http://www.pms.org.uk

The National Association for Premenstrual Syndrome (NAPS). Guidelines on Premenstrual Syndrome (2010).
Updated: June 2000.