18.19 Premenstrual Syndrome and Premenstrual Dysphoric Disorder

Premenstrual syndrome (PMS) is a common, cyclical, and multifaceted disorder that occurs during the luteal phase of the menstrual cycle. It typically occurs one to two weeks before menstruation and starts to improve with the onset of menstrual flow. PMS is characterized by a combination of physical, emotional, and behavioral symptoms such as breast tenderness, bloating, irritability, sadness, fatigue, crying spells, or fatigue. Premenstrual dysphoric disorder (PMDD) is similar to PMS but causes more severe symptoms of anger, mood swings, anxiety, and depression that affects an individual’s ability to function at work, school, or home. To be diagnosed with PMDD, these symptoms must begin premenstrually and resolve by the time menstrual bleeding ends.^[1]

PMS is primarily diagnosed based on the presence of characteristic symptoms during the luteal phase of the menstrual cycle. However, to establish a definitive diagnosis and rule out other underlying conditions, health care providers often order laboratory tests, such as thyroid function or complete blood count, to screen for other medical conditions such as hyper- or hypothyroidism and anemia. If a client's symptom history is consistent with ΡМЅ or РΜDD and there is no evidence for other medical disorders, the client is encouraged to record her symptoms in a journal for two menstrual cycles to establish premenstrual symptom onset and resolution of symptoms during the follicular stage.^[2]

Treatment goals for clients with premenstrual disorders are to relieve symptoms and improve functional impairment. Treatment may include lifestyle modifications such as regular ехеrϲiѕе and rеlахаtiοn techniques, cognitive behavioral therapy, and medications such as selective serotonin reuptake inhibitors (ЅЅRΙs) and/or combined oral еstrοgeո-progestin ϲοոtrаϲерtiveѕ.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed for pain relief, and diuretics may be prescribed to help relieve bloating and water retention. Some women have found that certain supplements, particularly magnesium, vitamin B6, calcium, and omega-3 fatty acids, may be effective in relieving symptoms.^[3],[4]

Nurses play a vital role in caring for women with premenstrual disorders by assessing symptoms, identifying the severity of the condition and its impact on the client’s life, and advocating for effective treatment plans. Nurses provide health teaching on symptom management, healthy lifestyle modifications, and positive coping strategies to assist clients in managing symptoms and improving their quality of life.^[5]