see also:

• gynaecology
• dysmenorrhoea

• refers to a symptom complex occurring monthly during the luteal phase (ovulation to menstruation but may last 3 to 21 days per cycle) of the menstrual cycle which includes:
  • nausea, vomiting, headache, nervousness, fatigue, diarrhoea, syncope, lower abdominal cramping, bloating, breast tenderness, mood changes, backache, and dizziness.
• premenstrual dysphoric disorder (PMDD) requires the presence of:
  • at least one of 4 core symptoms:
    • irritability
    • dysphoria
    • labile mood
    • tension
  • at least 5 of 11 other symptoms:

• alter the menstrual cycle
• change the body's response to the cycle
• treat the symptoms

• education
• aerobic exercise 3-4 times per week
• stress management
• dietary improvements

• vitamin B6 25mg bd and increase to 100mg/day
• vitamin E 400-600IU/day may help breast tenderness symptoms
• calcium 1000mg/d helps symptoms of water retention, abdominal cramps and mood changes
• magnesium 300-500mg/day in luteal phase may help mood changes and fluid retention
• evening primrose oil has not been shown to be effective in trials

• combined oral contraceptive pill (OCP)
  • monophasic may be more effective than triphasic
  • psychological symptoms may worsen
  • progesterone-only Rx do not appear to make much difference and may worsen anxiety and depression
• gonadotrophin releasing hormone agonists (GnRH agonists) obliterate the mesntrual cycle and improve physical symptoms although psychological symptoms may persist, and risk menopausal osteoporosis
• SSRI/SNRI antidepressants appear to be effective in Rx of severe PMS
• anxiolytics for duration of most severe symptoms only may have use with care.
• diuretics such as spironolactone 25mg tds during luteal phase may help bloating and water retention feelings but must be used with care.