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Case History

image Dr Oat is a 36-year-old museum curator with two children. She finds that she is 'like Jekyll and Hyde': two weeks of her cycle she is a warm, loving mother and wife, and calm, facilitating work colleague, but for the ten days before her period she knows she screams at the children, hates her staff and feels very miserable and 'out of control'. She cannot bear going on like this.

How should you assess her?

What are the treatment options?


image Many women notice changes in their emotional and physical feelings during the menstrual cycle. These disturbances are very variable. Different women have different symptoms and these may vary from month to month in both type and severity. There are no biochemical or other physical markers for the condition and premenstrual syndrome (PMS) may represent several heterogeneous syndromes.1 O'Brien gives the definition '…a disorder of non-specific somatic, psychological or behavioural symptoms recurring in the premenstrual phase of the menstrual cycle. Symptoms must resolve completely by the end of menstruation leaving a symptom-free week' (see Table 9.1). 'The symptoms should be of sufficient severity to produce social, family or occupational disruption. Symptoms must have occurred in at least four of the six previous menstrual cycles'.2 The symptoms vary but the most common ones include low mood, irritability, feeling out of control, anxiety, tension, clumsiness, poor memory, food craving, sleep disturbance, bloating, breast tenderness, abdominal pain, backache, weight gain and fatigue.

Table 9.1*DSM-IV* criteria for premenstrual dysphoric disorder

How should you assess her?

Essential questions to ask are:

  • How long has this been going on?

  • What contraception is she using?

  • What is her past psychiatric history?

Women should be asked to complete menstrual charts, recording their moods and other symptoms for at least two cycles. Three patterns may emerge:

  1. True PMS

  2. The menstrual pattern orchestrating underlying ...

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