Overview

• Distressing symptoms that occur in the luteal phase (day 15-28) of the menstrual cycle, in the absence of organic disease.
• Risk Factors → obesity, lack of exercise, dietary, smoking, family history.
• Affects 50-90% of women.

Making Diagnosis

Clinical Features

• Emotional Symptoms → mood swings, anxiety, stress, fatigue.
• Physical Symptoms → bloating, breast tenderness.
• Headache, lack of energy, changes in appetite, disturbed sleep pattern.

Progestogenic → depression, PMS, bleeding, acne, weight gain.

Oestrogenic → headache, nausea, breast tenderness.

Investigations

• Diagnosis requires a symptoms diary over 2 cycles.

Management Plan

• Mild (to everyone) → lifestyle advice.
  • Diet, sleep, exercise, smoking and alcohol advice.
  • Stress reduction, alcohol + caffeine limitation.
  • Regular, frequent (2–3 hourly), small, balanced meals rich in complex carbohydrates.
• Moderate (some impact on personal, social and professional life) → COCP (1ST LINE). Referal for CBT.