Clinical features

Most women experience at least mild 'physiological' premenstrual symptoms at some time in their lives. There are no specific signs of the syndrome, so the problem is best delineated on the basis of a history and symptom diary kept over 2-3 months.

Features may be classified into:

• physical
  • joint pain, muscle pain, back pain
  • breast tenderness or pain
  • abdominal swelling or bloating
  • headaches
  • skin disorders
  • weight gain
  • swelling of extremities (hands or feet or both)
• psychological and behavioural symptoms
  • changes in appetite, overeating, or specific food cravings
  • fatigue, lethargy, or lack of energy
  • mood swings (for example, feeling suddenly sad or crying, increased sensitivity to rejection)
  • irritability
  • anger
  • sleep disturbances
  • restlessness
  • poor concentration
  • social withdrawal
  • not in control
  • lack of interest in usual activities
  • loneliness
  • anxiety
  • depressed mood
  • confusion
  • tension
  • hopelessness (1)

Patients may complain of predominantly physical symptoms, predominantly psychological symptoms, or both (1). Symptoms tend to worsen markedly about six days prior to menses and peak at two days beforehand and there is always a symptom-free time in the cycle, usually after starting the period.

A study of 7226 women has revealed that the most common symptoms were of the physical domain: abdominal bloating, irritability, mastalgia and joint/muscle/back pains

Oedema may be severe, some women gaining up to 1 kg in weight in the latter part of the menstrual cycle.

Reference:

1. O'Brien S et al. Diagnosis and management of premenstrual disorders. BMJ. 2011;342:d2994.