Premenstrual syndrome (PMS) describes the emotional and physical symptoms that women may experience in the luteal phase of the normal menstrual cycle.

PMS only occurs in the presence of ovulatory menstrual cycles - it doesn't occur prior to puberty, during pregnancy or after the menopause.

PC

Emotional symptoms include:

• anxiety
• stress
• fatigue
• mood swings

Physical symptoms

• bloating
• breast pain

Management

Options depend on the severity of symptoms

• mild symptoms can be managed with lifestyle advice/conservatively
  • apart from the usual advice on sleep, exercise, smoking and alcohol, specific advice includes regular, frequent (2–3 hourly), small, balanced meals rich in complex carbohydrates
  • Vitamin supplementation: some evidence for vitamin B supplementation
  • Stress reduction: relaxation techniques
  • Cognitive behavioural therapy
• moderate symptoms may benefit from a new-generation combined oral contraceptive pill (COCP)
  • examples include Yasmin® (drospirenone 3 mg and ethinylestradiol 0.030 mg)
• severe symptoms may benefit from a selective serotonin reuptake inhibitor (SSRI)
  • this may be taken continuously or just during the luteal phase (for example days 15–28 of the menstrual cycle, depending on its length)