Evaluation and Support for PMS 

Dr. Kelsey Stang

Premenstrual Syndrome (PMS) is a common, cyclic condition that affects many women in their reproductive years. The symptoms associated with PMS can be disruptive and have a significant impact on a woman’s quality of life. 

As healthcare providers, understanding how to evaluate and treat PMS is crucial for providing effective care. This article will explore initial evaluation and treatment of PMS based on current research and clinical guidelines.

Evaluating for PMS

Start by taking a detailed medical history and symptom recall. Ask the patient about the onset, duration, and severity of her symptoms. Document the timing of the symptoms, which typically occur in the luteal phase of the menstrual cycle (1). 

One standardized tool to use is the Daily Record of Severity of Problems (DRSP) to assess the severity of PMS symptoms and whether PMDD is in the differential diagnosis. Common PMS symptoms include mood swings, irritability, breast tenderness, bloating, and fatigue.

It is important to rule out other conditions that may mimic PMS symptoms, such as depression, anxiety, thyroid disorders, and irritable bowel syndrome. Careful consideration for the patient’s psychiatric, medical history and current situations can help guide proper diagnosis.

Comprehensive evaluation also includes encouraging patients to keep a menstrual diary to monitor the timing and intensity of their symptoms over at least two menstrual cycles. This will help establish a pattern of assessment and ensure the symptoms are related to the menstrual cycle.

Comprehensive testing for hormone levels to assess estrogen and progesterone levels, thyroid function, vitamin D status and other potential contributing factors should also be considered. 

Treatment options for PMS

Lifestyle Modifications: These can have a significant impact on symptom management. Suggest regular exercise, a balanced diet, stress reduction techniques, and adequate sleep (2).

Supplement options: Certain supplements, such as calcium, magnesium, vitamin D, essential fatty acids (EFA) and vitamin B6, have shown promise in reducing PMS symptoms. Multiple studies found improvement in PMS symptoms with vitamin D supplementation in women who were vitamin D deficient (3, 4).  Another study found improvement in PMS symptoms with magnesium, B6 and EFA supplementation (5). Zinc also proved to improve symptoms when taken regularly over 12 weeks (6).  

In addition to optimizing nutrients, herbal preparations such as Vitex Angus Castus have also proven to alleviate PMS symptoms in women (7). One study found a 93% improvement of PMS symptoms in women after 3 months of intervention (8).  A systematic review of acupuncture and herbal medicine as effective treatment options for PMS showed an improvement in PMS as well (9). 

Nonpharmacological Interventions: Cognitive-behavioral therapy (CBT) and mindfulness-based relaxation techniques have been found to be effective in managing PMS symptoms, particularly those related to mood (10).  

Pharmacological Management: In cases where symptoms are severe, unresponsive to above treatments and significantly impact the patient’s daily life, pharmacological interventions may be indicated. The following options have shown efficacy in clinical studies:

a. Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs, like fluoxetine or sertraline, are often used to treat mood-related symptoms of PMS. They can be taken continuously or during the luteal phase (11).  

b. Oral Contraceptives: Some oral contraceptives, especially those containing drospirenone and ethinyl estradiol, can help regulate the menstrual cycle and reduce PMS symptoms. Several studies have also shown limited benefits, numerous adverse effects and no statistically significant improvement using OCP compared to placebo (12, 13). 

c. Gonadotropin-Releasing Hormone (GnRH) Agonists: These are occasionally used for severe PMS cases but are typically reserved for those who do not respond to other treatments or who have been diagnosed with PMDD..

d. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs can help relieve physical symptoms such as bloating and breast tenderness (14). 

Patient Education: Provide your patient with information about PMS and the management options available. Encourage open communication, addressing any concerns or questions she may have.

Follow-Up: Schedule regular follow-up appointments to monitor the effectiveness of the chosen treatment. Adjust the treatment plan as necessary to achieve the best results for your patient.

Conclusion

Evaluating and treating PMS requires a comprehensive approach that takes into account both nonpharmacological and pharmacological options. As healthcare providers, it is essential to engage in open and empathetic communication with patients experiencing PMS and provide evidence-based care that aligns with their individual needs and preferences. By staying informed about the latest research and clinical guidelines, healthcare providers can offer the best possible care to women with PMS, ultimately improving their quality of life.