For clinical diagnostic evaluation of Premenstrual syndrome(PMS) or Late luteal phase dysphoric disorder(LLPDD), a complete psychiatric interview should be performed during the non-symptomatic phase with a shorter supplement during the symptomatic phase. A self rating retrospective questionnaire and a prospective self rating is needed during at least 2 late luteal symptomatic periods and 2 mid-follicular non-symptomatic periods. For the accurate assessment of the changes in symptoms, several scoring methods were suggested, in which the NIMH guideline using the percent change method suggested by Rubinow and associates is widely used.
Although numerous etiolgical hypothesis have been proposed as development or expression of symptoms of PMS. It´s etiology is still unclear, and there is no consistent evidence the PMS is related to abnormal circulating levels of gonadal hormones. Recently, the symptoms of premenstrual syndrome may be triggered by hormonal events occurring before the late luteal phase of the menstrual cycle, in consistent with reports that the supression of ovulation results in remission of PMS symptoms. Some reports suggested that the symptoms of PMS could be resulted from abnormal sensitivity or responsiveness to the normal physiology of the menstrual cycle, and others suggested that PMS was a variant of affective disorder because of the similarity in symptoms and biological aspects between the disorders. A multidimensional, impairment of homeostasis which involves gonadal hormone, neurotransmitters and other biological & psychological process is a plausible hypothesis.
In symptom-oriented psychopharmacological treatment for PMS, there has been some success using antidepressants, alprazolam, buspirone. With present choice, the relatively specific 5-HT reuptake blocker fluoxetine seems promising for treatment of dysphoric PMS.
Hormonal treatment trial, which were aimed of suppression of ovulation with GnRH, danazol or estrogen were shown to effectively treat severe PMS. In future, well designed, controlled studies using a proper diagnosed PMS and long term follow up studies should be performed using TCAs, MAOIs as well as non-antidepressant serotonergic agents.
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