Treatment strategies for premenstrual syndrome.

Premenstrual syndrome (PMS) refers to a group of menstrually related disorders. Premenstrual symptoms sufficient to impair daily activity and relationships are estimated to occur in up to 40 percent of women of reproductive age, with 5 percent of these women having severe impairment. Although no single causative factor has been identified, PMS is related to ovulatory cycles and resolves at menopause. A specific diagnostic test for PMS does not exist. Treatment is based on the symptoms. Oral contraceptive agents, diuretics and antidepressants have been used successfully to relieve symptoms. Cognitive therapy may help the patient develop appropriate ways to cope with the obstacles, frustrations and discomforts of daily life. Although dietary deficiencies may be difficult to demonstrate, nutritional supplementation may result in significant improvement. Various treatments, including progesterone supplementation, vitamin B6 in high doses, alprazolam and gonadotropin-releasing hormone agonists, are generally not recommended. A comprehensive treatment plan that encourages a healthy lifestyle may relieve symptoms in most women.