Gynecological management of premenstrual symptoms.

The vast majority of menstruating women experience uncomfortable symptoms during the premenstrual phase of their menstrual cycles. Although many women do not require specific treatment of their symptoms, approximately 20% to 50% report moderate to severe premenstrual symptoms and about 5% meet the diagnostic criteria for premenstrual dysphoric disorder, the most severe manifestation of premenstrual symptoms. While the etiology of premenstrual symptoms remains unclear, several theories have implicated sex steroids and neurotransmitters in the development and manifestation of symptoms. Further complicating the delineation of etiology is that premenstrual symptoms can be somatic, psychological, or behavioral, as well as a combination of all three. Developing successful interventions for premenstrual symptoms has thus been challenging, with interventions focused on a particular aspect of premenstrual symptomatology. Treatments for premenstrual symptoms include lifestyle changes, cognitive behavioral therapies, and pharmacologic agents including ovulation suppression regimens, antidepressant medications, and anxiolytics.