Evidence-based management of premenstrual syndrome

Premenstrual syndrome (PMS) can be a source of real distress and discomfort to menstruating women. There is a spectrum of severity from one end where women have mild symptoms to the severe end that is premenstrual dysphoric disorder. These symptoms may be so severe that they disrupt the normal functioning, quality of life and interpersonal relationships. It is critical to note the cyclical nature of the condition. The definitive aetiology of PMS remains obscure though it appears to be directly related to the ovarian hormone cycle. The management of PMS is based on the principles of ovulation suppression or correction of the neurotransmitter deficiency, which is considered to be responsible for the cyclical symptoms. There are numerous studies evaluating the various treatment options available. Apart from conservative management involving lifestyle and diet changes, these are followed by other options like hormonal and non-hormonal drug treatment, particularly selective serotonin re-uptake inhibitors that are available as effective alternatives. Further treatment measures like medical oophrectomy with GnRH analogues and surgical oophrectomy are considered for severe cases.