Those few horrible days: Premenstrual syndrome

Premenstrual syndrome (PMS) is a distinct clinical syndrome during the recurrent luteal phase of menstrual cycle wherein there is a significant deterioration in the quality of life due to disruptive physical and psychiatric symptoms caused by an abnormal central nervous system response to the hormonal changes of the female reproductive cycle. It happens in the postovulation phase because estrogen and progesterone levels fall dramatically if there is no pregnancy. Physical symptoms include breast tenderness and bloating sensation, and emotional symptoms may manifest as mood swings, depression or feeling of hopelessness, intense anger and conflict with others, tension, anxiety, irritability, decreased interest in usual activities, difficulty in concentrating, fatigue, and changes in appetite. Symptoms emerge 1–2 weeks before menses and resolve completely with the onset of menses. This review article outlines the pathophysiology, presentation, severity and timing of symptoms, diagnosis and treatment of PMS and reiterates that it is a transient and physiological phase during the menstrual cycle and not a pathological entity.