The premenstrual syndrome is discussed in relation to prevalence, symptomatology, severity, and time course. Methodologic problems common to the study of the menstrual cycle are presented. The research on psychologic and physiologic etiologies is reviewed, and results of studies on various treatment modes are discussed. Newer theories suggesting a combined psychophysiologic etiology and concomitant nonpharmaceutical treatment modes encompassing self-care and stress management skills are included.
PIP: This article reviews current knowledge of the symptoms, etiology, and treatment of premenstrual syndrome. The wide variability in symptoms defined as comprising the premenstrual tension syndrome has resulted in variability in reported prevalence rates. Research in this area has been characterized by methodologic flaws such as a lack of a control group. For example, uncontrolled studies have generally shown that oral contraceptive (OC) users have a lesser incidence and severity of premensrual symptoms than nonusers; however, many women who experience an increase in symptoms with OC use discontinue their use, leaving a biased sample of OC users. Most widely accepted at present is the theory that physiologic factors cause premenstrual symptoms, while personality factors and social stresses exacerbate these symptoms. Recent research has focused on the interaction of psychologic and physiologic factors in the etiology of the premenstrual tension syndrome. Nonpharmacologic treatment modes encompassing self-care and stress management skills have proven effective. Such an approach has no undesirable side effects and increases women's sense of control over psychophysiologic processes. Group therapy, aimed at correcting stereotypes about premenstrual tension and modifying perceptions of menstrual pain as degrading, is emerging as a particularly effective treatment modality. Stress management techniques often enable women to break the cycle in which stress leads to sympathoadrenomedullary arousal that precipitates further stress.