Premenstrual Syndrome (PMS)
The premenstrual syndrome occurs during the luteal (premenstrual phase) of the menstrual cycle. It refers to the occurrence of cyclical somatic, psychological and emotional symptoms and it resolves by the time menstruation ceases. It is idiopathic in most cases. However, possible causes include low serotonin levels, family history, and variation in sex steroid levels. Risk factors include high caffeine intake, stress, increasing age, history of depression, and a diet low in minerals and vitamins. Patients with PMS usually present with mood swings, bloating, abdominal cramps, extreme fatigue, cyclical weight gain, headache, and mastalgia. Treatment includes lifestyle modifications and stress management. SSRIs and cognitive behavioral therapy also help in the improvement of symptoms. Other options include cycle suppression by COCPs and surgery (hysterectomy plus bilateral salpingo-oophorectomy) in resistant cases. Primerose oil has no evidence of true benefit, but it might be helpful for mastalgia.