Making gynecological and psychiatric sense out of premenstrual pains, tension and dysphoria

OBJECTIVE: Millions of women worldwide suffer from a variety of gynecological and psychiatric syndromes that are specifically linked to the late luteal phase of menstrual cycle and hence, need proper treatment for good quality of life. The objective of this qualitative review is to examine the latest developments in the etiology, diagnosis and treatment of premenstrual syndrome and its connections to premenstrual dysphoric disorder.

METHODS: A selective search of MEDLINE/PubMed retrieved numerous peer-reviewed papers published in international journals for the past 10 years (the search was ended in 2003), which were screened extensively, but only the latest and most relevant articles were included in this review.

RESULTS: The 2 main premenstrual disorders manifesting tension, dysphoria and pain were etiologically attributed best to the dysregulation of central serotonergic and GABAergic systems and noxious sex steroid hormonal milieu during normal cyclical ovulation. The women with these syndromes needing proper assessment, investigations and correct diagnosis respond effectively to selective serotonin-reuptake inhibitors, gonadotrophin-releasing hormone agonists, contraceptive pill-Yasmin, cognitive-behavior therapy, life-style changes, and also placebo.

CONCLUSION: Premenstrual psychiatric syndromes coupled with multiple adverse consequences are important clinical entities in a woman's reproductive life, which need timely intervention and future research especially in Arabian Gulf countries.