Patient must have:

• > 1 affective symptoms
• > 1 somatic symptoms
• Begins at least 5 days prior to onset of menses, for 3 consecutive cycles, and ceases within 4 days of the onset of menses

• Depression
• Angry outbursts
• Irritability
• Anxiety
• Confusion
• Social withdrawal

• Breast tenderness
• Abdominal bloating
• Headache
• Swelling of extremities

• Insomnia
• Hypersomnia
• Mastalgia
• Bloatedness
• Weight gain
• Joint pain
• Generalized pain
• Relationship issues
• Worsening of underlying disorders (criminal behavior, suicidal ideation, absenteeism)

• PMS symptoms must persist for a year
• Must clearly differentiate from a catamenial trigger of other underlying disorders

• Age > 30 yrs
• Family history (mother and sisters)
• Stress (?) or response to stress
• History of traumatic events (childhood sexual abuse, severe accidents, severe physical threat history)

Triggered by premenstrual period and do not count as diagnosis of PMS or PMDD

• Seizures
• Migraines
• Irritable bowel disease
• Diabetes
• Asthma
• Rheumatoid arthritis

• Education of expectations
• Aerobic exercise
• Stress management
• Accupressure and accupuncture
• Chiropractic adjustment (?)
• Phototherapy
• Cognitive behavioral therapy

Increase carbs

• Helps with mood, memory, carbohydrate craving
• Complex carbs are less likely to be craved, but may satisfy cravings with less weight gain

Decrease sodium, alcohol, and caffeine

• Helps with water retention and mood
• May be related to magnesium deficiency

Low fat high figer diet throughout the month

• May lessen excursions of estrogen and progesterone through the cycle

Vitamin B6

• 50-100mg/day
• >100mg/day may lead to neuropathies

Calcium

• Shows benefit in reduction of water retention, food cravings, and generalized pain
• 1200-1500mg/day (divided) of calcium carbonate

• May reduce irritability, mood alteration, anger, headache, and breast tenderness
• May alter estrogen and progesterone production by corpus luteum
• Should NOT be used during pregnancy or lactation
• 20mg/day MAX dose

• Improve breast tenderness, fluid retention, mood
• May increase bleeding risk, and has multiple CYP450 interactions

• Similar but less side effects as SSRI's
• More drug interactions than SSRI's
• Should not generally be recommended

• Used to treat PMS symptoms for centuries
• Not effective in clinical trials, except for the reduction of breast pain and tenderness

• May help reduce generalized pain and breast tenderness
• Dose starting on day 15 through 5 of cycle
• Dose around the clock rather than PRN
• Naproxen is moderately superior to ibuprofen

• May help treat the symptoms of breast tenderness, bloating, and fluid weight gain
• Some sources suggest using only in women with regular weight gain > 3 lbs during luteal phase of cycle

• Dopamine agonist
• Reduces prolactin levels
• Usefulk only to treat breast symptoms (pain, tenderness, fullness)
• Cautious use in those with HTN
• Should NOT use in those with seizure disorders

• DOC for severe PMS and PMDD
• Improves all psychological and many physical manifestations of the disease
• PMS symptoms respond much quicker than does depression to SSRI therapy
• The use of intermittent SSRIs is typically as effective with fewer toxicities

• COP containing drosperinone (YAZ)
• Has anti-mineralocorticoid and pro-estrogenic effects

• GnRH Agonists
• Leuprolide, Danazol
• Results in initial surge of LH and FSH, but within 1-4 weeks, results in suppression of LH and FSH

• No more than 6 months 
• Will cause hot flashes and may cause osteoporosis