Premenstrual Syndrome or Premenstrual Tension

Definition-
It is defined as a group of symptoms,both physical and behavioral that occur in the second half of the menstrual cycle and both often interfere with work and personal relationship.
Incidence-
Prevalence rate is 5% to 95% of menstruating women , about 40% of women are significantly affected at one time or another.Severe symptoms occur in only 2% or 3% of women between the ages of18 and 48.
Probable cause-
Vitamin B6 deficiency
Fluid retention
Hypoglycemia
Endogenous hormone alterations-altered oestrogen: progesterone ratio
Inappropriate prostaglandins activity
Elevated monoamine oxidase (MAO)
Decrease synthesis of serotonin
Suppression of ¥-aminobytyric acid (GABA)
Endorphins malfunction
Multiple psychologic disturbance.
Diagnosis-
History taking
Physical examination
No laboratory test is required
Symptoms diary
Diagnosis is confirmed by administration of GnRH analogue, goserelin 3.6 mg in the from if depot at monthly intervals for 3 months.if the symptoms are relieved along with amenorrhea PMS is confirmed.
Symptoms-
Somatic symptoms
Bloated feeling
Discomfert in lower abdomen
Feeling of weight gain
Breast pain or tenderness
Skin disorders
Hot flushes
Pelvic pain
Change in bowel habits
Swelling in extremities
Psychological symptoms
Irritability
Aggression
Tension
Anxiety
Depression
Lethargy
Insomnia
Change in appetite
Crying
Change in libido
Thirst
Loss of concentration
Poor coordinations
When this symptoms disrupt daily functioning they are grouped under the  name premenstrual dysphoric disorder (PMDD).
Diet and exercise
High -protein,well -balanced diet.
Supplemental vitamin -pyridoxine 50mg per day
Exercise and Yoga .
Avoidance of sult, caffeine and alcohol.
Treatment-
Psychotherapy
Diuretic-Frusemide 40mg daily given for a week before menstruations
Diazepam 5mg daily
Oral progesterone- norethisterone 5mg thrice daily or dydrogesterone 10 mg twice daily from the 16th to 25th dah of the cycle for 3-6cycle.
Selective serotonin reuptake inhibitor (SSRI).
Bromocriptine 2.5mg daily or twice daily.
Suppression of ovarian cycle by-Danazol 200 -400mg daily in divided close
GnRH analogue-Goserelin, Leuprorelin

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