5 - Premenstrual Syndrome

Summary

Premenstrual symptoms in women are a common phenomenon, and the clinician must perform a careful medical and psychological screening to evaluate the severity of the symptoms as well as to rule out comorbid psychiatric and medical disorders. Progress in defining the premenstrual syndrome (PMS) in the past two decades has allowed recent studies to begin to elucidate the etiology and treatment of premenstrual symptoms. This chapter reviews the diagnostic issues, epidemiological variables, pathogenetic hypotheses and the treatment options now available to treat PMS.

History

The term ‘premenstrual tension’ was coined by Frank 70 years ago (Frank et al., 1937), but descriptions of emotional symptoms being related to menstruation date back to antiquity (Severino & Moline, 1989). In the past two decades, progress has been made in defining premenstrual symptoms, assessing prevalence and predictors, searching for etiologies and assessing the efficacy of pharmacological and nonpharmacological treatments. Research criteria for definitions of severe premenstrual symptoms have existed in the two most recent editions of the Diagnostic and Statistical Manual of Mental Disorders, DSM-III-R (1987) and DSM-IV (American Psychiatric Association, 1994). Although some authors question the validity of disturbing premenstrual symptoms as constituting an ‘illness’ (Gurevich, 1995; Richardson, 1995), the existence of research diagnostic criteria has expanded the knowledge about the etiology and treatment of premenstrual symptoms.

PMS can be defined as emotional, behavioral and physical symptoms that occur in the luteal phase of the menstrual cycle of women, with resolution of the symptoms following the menses.