Premenstrual syndrome.
Most women of reproductive age have some physical discomfort or dysphoria in the weeks before menstruation. Symptoms are often mild, but can be severe enough to substantially affect daily activities. About 5-8% of women thus suffer from severe premenstrual syndrome (PMS); most of these women also meet criteria for premenstrual dysphoric disorder (PMDD). Mood and behavioural symptoms, including irritability, tension, depressed mood, tearfulness, and mood swings, are the most distressing, but somatic complaints, such as breast tenderness and bloating, can also be problematic. We outline theories for the underlying causes of severe PMS, and describe two main methods of treating it: one targeting the hypothalamus-pituitary-ovary axis, and the other targeting brain serotonergic synapses. Fluctuations in gonadal hormone levels trigger the symptoms, and thus interventions that abolish ovarian cyclicity, including long-acting analogues of gonadotropin-releasing hormone (GnRH) or oestradiol (administered as patches or implants), effectively reduce the symptoms, as can some oral contraceptives. The effectiveness of serotonin reuptake inhibitors, taken throughout the cycle or during luteal phases only, is also well established.
Yonkers
Kimberly Ann
KA
Department of Psychiatry, Yale School of Medicine, CT 06510, USA. Kimberly.Yonkers@yale.edu
O'Brien
P M Shaughn
PM
Eriksson
Elias
E
D000293:Adolescent; D000328:Adult; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D005260:Female; D006801:Humans; D019964:Mood Disorders / Q000209:etiology; D016584:Panic Disorder / Q000209:etiology; D011293:Premenstrual Syndrome / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
D003278:Contraceptives, Oral, Hormonal; D017367:Selective Serotonin Reuptake Inhibitors