What is premebstrual symptoims?/

national Society for Premenstrual Disorders (ISPMD) has made recommendations for a new classification with  Type A) core (the typical, pure or reference disorders associated with spontaneous ovulatory menstrual cycles) and Type B)  variant premenstrual disorders (such as symp­toms of an underlying psychological or somatic disorder significantly worsening premenstrually).

• Aetiology

  PMS is related to cyclical ovarian function as it is absent before the menarche and is cured by the menopause. However, the way in which ovarian steroids provoke luteal symptoms which may start at different times (just after ovulation, or just before menstruation) are unclear. The importance of progesterone compared with oestrogen in triggering

    Many International authorities issued guidelines about the definition of PMDD . To diagnose this disease require at least five of 11 symptoms during the luteal phase. Symptoms must resolve soon after menses start and be absent after menses. At least one symptom must be among the first four listed:

    To diagnose PMS one should have at least 6 symptoms and exclusion of previous psychiatric illness is essential. Depressed mood, Physical symptoms (breast tenderness, headaches, bloating, weight gain Significant anxiety.. ffective disorders ,Concentration difficulty, Insomnia or hypersomnia

  Persistent anger or irritability. Sense of being overwhelmed, Decreased interest in usual activities

  Lethargy,Change in eating habits

  ).

  The symptoms severely interfere with usual activities and relationships. Symptoms should not be associated with another psychiatric disorder.

  Evidence must be recorded in a diary for at least two symptomatic menstrual cycles.

  symptoms is also uncertain. Mood change reported by postmenopausal women taking sequential hormone replacement therapy suggests that progesterone, rather than oestrogen, is responsible for inducing dys­phoria. Furthermore, oestrogen exerts an antidepressant effect in women with perimenopausal depression. On the other hand, oestradiol can provoke PMS-like complaints and luteal administration of an oes­trogen antagonist reduces premenstrual mastalgia.

  Evidence suggests that women with and without PMS do not differ with respect to the production of gonadal steroids, indicating that PMS might instead be associated with enhanced responsiveness to normal, fluctuating concentrations of these hormones.

  Neurotransmitters must be involved in PMS as mood changes are important symptoms. The most important candidate is serotonin and indeed selective serotonin reuptake inhibitors (SSRIs) are effective treatment.. In addition, oestrogen has antidopaminergic properties and progesterone modulates gamma aminobutyric acid, the neurotransmitter involved in emotional control.

  Assessment

  It is essential to listen to the woman and take her complaint seriously. She may have asked other doctors for help in the past without success and may be aggrieved that she has been dismissed. Essential questions to ask are:

  What are the symptoms?

  How long has this been a problem?

  What is your menstrual history?

  What contraception is being used?

  Is there a past history of psychiatric problems or traumatic events?

  The diagnosis of PMS and PMDD requires daily charting of symptoms over two or three menstrual cycles because of the variability of symp­toms. Various scoring systems and diaries have been developed for this purpose, such as the Daily Record of Severity of Problems and the Moos Menstrual Distress Questionnaire.While women may be reluctant to participate in such an exercise, perceiving it as a way of delaying treatment, it is essential to distinguish between:

  true PMS/PMDD

  premenstrual exacerbation of an underlying psychiatric disorder

  a condition with no relation to the menstrual cycle.