Summary
Definition
History and exam
Key diagnostic 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 flashes
Risk factors
- postpubescent and premenopausal women
- family history
- mood disorders
- cigarette smoking
- white women
- sexual abuse and/or trauma
- alcohol consumption
Diagnostic investigations
1st investigations to order
- prospective symptom diary
Investigations to consider
- thyroid function tests
- follicle-stimulating hormone levels
- depression screening
- CBC
Treatment algorithm
mild PMS
moderate to severe PMS or PMDD
Contributors
Authors
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
Dr Nancy A. Phillips and Dr Gloria Bachmann would like to gratefully acknowledge Professor Margaret Rees and Dr Desiree Lie, the previous contributors to this topic.
Disclosures
MR and DL declare that they have 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
- Generalized anxiety disorder
More DifferentialsGuidelines
- Management of premenstrual syndrome
- Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder
More GuidelinesPatient leaflets
Premenstrual syndrome
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