Premenstrual syndrome

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Pathogenesis:

PMS appears to result from the interaction of cyclic changes in ovarian steroids with central neurotransmitters. The neurotransmitter which is most implicated in the 

manifestations of PMS is serotonin. There may also be a role for trace elements in the pathogenesis of PMS. There are no consistent personality differences. While PMS may be a cause for stress, stress does not seem to affect the incidence or severity of PMS

Table 1: UCSD criteria for Premenstrual syndrome

  • The presence by self report of at least one of the following somatic AND affective symptoms during the five days prior to menses in each of three menstrual cycles

Affective Somatic

Depression Breast tenderness

Irritability Abdominal pain

Confusion Headache

Social withdrawal Swollen extremities

Fatigue


Angry outbursts
  • Relief of the above symptoms within four days of onset of menses with no recurrence until at least day 12 of cycle.

  • Presence of symptoms in the absence of any pharmacologic therapy, hormone ingestion, drug or alcohol use

  • Identifiable dysfunction in social or economic performance

    by one of the following criteria

Marital or relationship discord confirmed by the partner

Difficulties in parenting

Poor work or school performance, attendance/ tiredness

Increased social isolation

Legal difficulties

Suicidal ideation

Seeking attention for a somatic symptom(s)

Physical and behavioural symptoms in 2nd half of menstrual cycle.

USCD criteria useful in diagnosis of PMS and deciding treatment.

Due to interaction of ovarian steroids with neurotransmitters notably serotonin.

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