Premenstrual syndrome

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Presentation of a case

A 24 year old woman complaints of cyclic bloating, feeling of distension, depression and episodes of anger occurring 4-5 days before the onset of menses. The symptoms are relieved by day 5 of the period. However she relates mantal discord and severe debility recessitating absenteeism during work. She does not drink and has not been treated for depression. She is not on any medicine.


Physical examination, CBC and thyroid functions are normal. Discussion: This patient most likely has PMS. The cyclicity, the absence of other illness and relief of following menstruation is indicative of the diagnosis.

Use of strict diagnostic criteria as detailed below is necessary so as not to miss underlying psychiatric illness. Many patients may have underlying psychiatric illness that may be misdiagnosed as PMS. The premenstrual syndrome (PMS,
also called late luteal phase dysphoric disorder) is characterized by the presence of both physical and behavioral symptoms that occur repetitively in the second half of the menstrual cycle. The UCSD criteria for the diagnosis of PMS is given in table 1.

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