CID EPISODE 1210 MANUAL
In the mid-1980s, a multidisciplinary US National Institutes of Health consensus conference on PMS proposed criteria that were adopted by the Diagnostic and Statistical Manual III (DSM III) 3 to define the severe form of this condition. The effectiveness of serotonin reuptake inhibitors, taken throughout the cycle or during luteal phases only, is also well established. Fluctuations in gonadal hormone levels trigger the symptoms, and thus interventions that abolish ovarian cyclicity, including long-acting analogues of gonadotropin-releasing hormone (GnRH) or oestradiol (administered as patches or implants), effectively reduce the symptoms, as can some oral contraceptives. We outline theories for the underlying causes of severe PMS, and describe two main methods of treating it: one targeting the hypothalamus-pituitary-ovary axis, and the other targeting brain serotonergic synapses.
Mood and behavioural symptoms, including irritability, tension, depressed mood, tearfulness, and mood swings, are the most distressing, but somatic complaints, such as breast tenderness and bloating, can also be problematic. About 5–8% of women thus suffer from severe premenstrual syndrome (PMS) most of these women also meet criteria for premenstrual dysphoric disorder (PMDD). Symptoms are often mild, but can be severe enough to substantially affect daily activities. Most women of reproductive age have some physical discomfort or dysphoria in the weeks before menstruation.
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