The etiology of premenstrual syndrome is unknown. A wide variety of etiological explanations has been suggested, but controlled studies based on these theories have generally failed to provide confirmation. This article reviews the literature on treatment of premenstrual symptoms and provides some practical suggestions for clinical management.
PIP: This article reviews the literature on the treatment of premenstrual symptoms and provides some suggestions for clinical management. Most studies report moderate to severe premenstrual changes in 20-30% of women. Premenstrual changes have been variously attributed to hormonal factors, fluid and electrolyte imbalance, pyridoxine deficiency, abnormal prostaglandin levels, neuroticism, endorphin imbalance or withdrawal, and fluctuations in monoamine oxidase levels. Most studies in this area are either uncontrolled or have serious methodologic flaws. Despite the current absence of knowledge about the etiology or proven effective treatment of premenstrual syndrome, clinical experience suggests a number of steps beginning with a complete physical, gynecologic, and endocrinologic examination. A daily patient diary of symptoms and their severity, collected over at least 2 full menstrual cycles, can be helpful to identify changes that are menses-related, repetitive, and have clearcut symptom-free intervals. Initial therapeutic management consists of education and support. Women are instructed to keep the premenstrual period as free of external stress as possible. If further intervention is required, a symptom-oriented approach targeted at the most prominent symptoms is recommended. The severity of symptoms and the degree of functional impairment should be weighed against the risks associated with pharmacologic agents. Routine use of diuretics is not advised. Psychosocial intervention, stress reduction, and dietary changes also may be effective. However, no consistently effective treatment for dysphoric premenstrual symptoms has been identified, most likely because the syndrome is not a single entity.