Premenstrual syndrome: an update on definitions, diagnosis and management

show at least a 30% increase from the intensity of symptoms measured in the follicular phase, that is, in days 5–10 of the menstrual cycle, compared with those measured in the premenstrual phase (on the 6 days before menstruation). In addition, premenstrual changes must be prospectively documented for at least two consecutive menstrual cycles. Some research authorities stipulate a 50% worsening of symptoms by the premenstrual phase (Steiner & Wilkins, 1996). The 30% change in ratings of symptoms has been shown to be too liberal and a poor discriminator when comparing women with self-reported severe PMS, women using contraceptives whose natural cyclicity has been suppressed and women with normal cyclicity who report no premenstrual symptoms (Gallant et al, 1992). Gallant et al emphasise that what may be more clinically relevant is women’s perceptions of variations in social and occupational functioning and “the way in which having PMS is meaningful in a woman’s life”. The authors’ concern is that ever more stringent criteria might result in the exclusion from studies or treatment of significantly troubled individuals. The diagnosis of PMS was operationalised with the introduction of the term ‘late luteal phase dysphoric disorder’ (LLPDD) into DSM–III–R (APA, 1987) under the section headed ‘Proposed diagnostic categories needing further study’. Subsequently, a work group on LLPDD reported to the DSM–IV Task Force, culminating in its inclusion in DSM–IV Most articles on the management of the premenstrual syndrome (PMS) begin by noting that the term “premenstrual tension” was first coined by R. T. Frank in 1931 and “pre-menstrual syndrome” by Greene & Dalton in 1953. However, in 1847, Dr Ernst F. von Feuchtersleben wrote: