Premenstrual syndrome: an update on definitions, diagnosis and management

Most articles on the management of the premenstrual syndrome (PMS) begin by noting that the term “premenstrual tension” was first coined by R. T. Frank in 1931 and “pre-menstrual syndrome” by Greene & Dalton in 1953. However, in 1847, Dr Ernst F. von Feuchtersleben wrote:

Treating premenstrual dysphoric disorder using serotonin agents

Premenstrual syndrome (PMS) affects 20%-50% of all women. Premenstrual dysphoric disorder (PMDD), which can be conceptualized as a more severe variant of PMS, can affect 3%-9% of all women. Because a significant number of women suffer from premenstrual disorders and afflicted women may spend up to half the month suffering from symptoms, it is important to identify and provide effective treatment for such women. Historically, it has been difficult to distinguish premenstrual disorders from other depressive disorders, given the high comorbidity of the two disorders. Most studies attempt to remove this confounding factor by excluding women with concurrent depressive disorders. Despite the difficulties and limitations inherent in studying treatments for premenstrual disorders, most investigations support the use of serotonin agents in treating PMDD.

Premenstrual syndromes

Premenstrual syndrome research has made a great deal of progress since 1983 when the criteria for the diagnosis were clearly defined. Confirming the diagnosis prospectively and ruling out other disorders was a major methodologic advance. The DSM-IV criteria for PMDD now help us identify and classify women who have severe psychologic symptoms during the premenstruum. Although we do not have a definitive cause for PMDD, the consensus is that it is the end result of a complex series of events mediated partly by the serotonin system and triggered by ovulation. Women who meet criteria for PMS, do not meet the criteria for PMDD, and do not have a concurrent disorder should be treated conservatively. Women who meet criteria for PMDD can be treated successfully with low-dose clomipramine, SSRIs, or GnRH-as with "add back" estrogen and progestins.