Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- abdominal bloating
- fatigue
- breast tenderness
- headaches
- depressed mood, irritability, and internal tension
- labile mood
- adverse effect on life
Other diagnostic factors
- increased appetite
- forgetfulness and difficulty concentrating
- other subjective symptoms
- insomnia or hypersomnia
- gastrointestinal upset
- heart palpitations
- hot flushes
Risk factors
- post-pubescent and premenopausal women
- family history
- mood disorders
- cigarette smoking
- white women
- sexual abuse and/or trauma
Diagnostic investigations
1st investigations to order
- symptom diary
Investigations to consider
- thyroid function tests
- follicle-stimulating hormone levels
- depression screening
Treatment algorithm
mild PMS
moderate to severe PMS or PMDD
Contributors
Authors
Margaret Rees, MA, DPhil, FRCOG
Editor in Chief
Maturitas
President
European Menopause and Andropause Society
Reader Emeritus in Reproductive Medicine
University of Oxford
Women's Centre, John Radcliffe Hospital
Oxford
Visiting Professor
Faculty of Medicine
University of Glasgow
Glasgow
UK
Adjunct Associate Professor
Robert Wood Johnson Medical School
Rutgers University
New Brunswick
NJ
Disclosures
MR declares that she has no competing interests.
Nancy A. Phillips, MD
Associate Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Rutgers Robert Wood Johnson Medical School
New Brunswick
NJ
Disclosures
NAP declares that she has no competing interests.
Gloria Bachmann, MD
Professor
Department of Obstetrics, Gynecology and Reproductive Sciences
Rutgers Robert Wood Johnson Medical School
New Brunswick
NJ
Disclosures
GB declares that she has no competing interests.
Acknowledgements
Professor Margaret Rees, Dr Nancy A. Phillips, and Dr Gloria Bachmann would like to gratefully acknowledge Dr Desiree Lie, the previous contributor to this topic. DL declares that she has no competing interests.
Peer reviewers
Julianne Toohey, MD
Obstetrician-Gynecologist
Department of Obstetrics and Gynecology
University of California Irvine Medical Center
Orange
CA
Disclosures
JT declares that she has no competing interests.
Carol Henshaw, MB ChB, MD
Consultant in Perinatal Mental Health
Liverpool Women's NHS Foundation Trust
Liverpool
UK
Disclosures
CH declares that she has no competing interests.
Differentials
- Depression
- Thyroid disease
- Generalised anxiety disorder
More DifferentialsGuidelines
- Management of premenstrual syndrome
- ISPMD consensus on the treatment of premenstrual dysphoric disorder (PMDD)
More GuidelinesPatient leaflets
Premenstrual syndrome
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