Premenstrual syndrome

Mary Ann Lumsden, Margaret Rees
In: Menstrual Problems for the MRCOG and Beyond · 2014 · pp. 139–146 · doi:10.1017/cbo9781107445208.014 · W2309169477
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-13 ⓘ

This paper reviews surgical options for menstrual problems, comparing endometrial ablation techniques with hysterectomy and noting hysterectomy offers guaranteed amenorrhea with higher patient satisfaction.

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This chapter reviews premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), describing that diagnosis depends on daily symptom charting over two or three menstrual cycles because symptoms vary between cycles. It reports that across randomized controlled trials of PMS treatments, the placebo response is consistently very high (about 60% improvement), and it emphasizes understanding the woman’s problems as potentially most therapeutic. For treatment, it states that selective serotonin reuptake inhibitors (SSRIs) are proven safe and effective for PMDD, while hormonal therapies that suppress ovulation can be used when SSRIs or second-line psychotropic agents are ineffective. It also covers evaluations of herbal and vitamin supplementation and complementary/alternative medicine for PMS/PMDD, but notes that evidence is framed by the high placebo response seen in trials. Relevance to endometriosis: endometriosis is discussed within the same menstrual-problem framework and adjacent sections of the book, though this specific PMS/PMDD chapter focuses primarily on PMS/PMDD rather than endometriosis.

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Abstract

The surgical options for the management of menstrual problems are chiefly endometrial ablation as a uterine conserving procedure and either total or subtotal hysterectomy, which can be performed by a number of routes. Endometrial ablation represents the most thoroughly evaluated surgical treatment to date. Endometrial techniques are divided into first generation and second generation techniques. First generation techniques include transcervical resection of the endometrium (TCRE), rollerball endometrial ablation (RBEA), and endometrial laser ablation (ELA). They offer the benefit of direct vision and require a fluid distension media. Second generation techniques are: thermal balloon ablation, microwave endometrial ablation (MEA), NovaSure, Hydro ThermAblator, and cryosurgical ablation. Second-generation ablative techniques have been evolved to simplify the technique and ideally place endometrial ablation safely in the hands of all gynaecologists. Total hysterectomy is the only surgical treatment for menstrual problems that guarantees amenorrhoea. Satisfaction with hysterectomy is higher than that with ablation.
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- Menstrual Problems for the MRCOG and Beyond - Series page - Menstrual Problems for the MRCOG and Beyond - Copyright page - Contents - Abbreviations - Preface - Editors - Contributors - 1 Introduction - 2 Excessive menstrual bleeding - 3 Investigation - 4 Medical management of excessive menstrual bleeding - 5 Surgical management of menstrual problems - 6 Uterine fibroids and heavy menstrual bleeding - 7 Dysmenorrhoea - 8 Endometriosis - 9 Chronic pelvic pain - 10 Delayed menarche - 11 Premature ovarian failure - 12 Polycystic ovary syndrome - 13 Premenstrual syndrome - Index Published online by Cambridge University Press: 05 June 2014 Book contents - Menstrual Problems for the MRCOG and Beyond - Series page - Menstrual Problems for the MRCOG and Beyond - Copyright page - Contents - Abbreviations - Preface - Editors - Contributors - 1 Introduction - 2 Excessive menstrual bleeding - 3 Investigation - 4 Medical management of excessive menstrual bleeding - 5 Surgical management of menstrual problems - 6 Uterine fibroids and heavy menstrual bleeding - 7 Dysmenorrhoea - 8 Endometriosis - 9 Chronic pelvic pain - 10 Delayed menarche - 11 Premature ovarian failure - 12 Polycystic ovary syndrome - 13 Premenstrual syndrome - Index Premenstrual syndrome (PMS) is a common problem which can markedly interfere with normal life. Most women have one or more emotional or physical symptoms in the premenstrual phase of the menstrual cycle. The diagnosis of PMS and premenstrual dysphoric disorder (PMDD) requires daily charting of symptoms over two or three menstrual cycles because of the variability of symptoms. Understanding the woman's problems is essential and indeed may be the most therapeutic option. The one consistent factor in randomized controlled trials on any of the PMS treatments is the very high placebo response - about 60% improvement. Selective serotonin reuptake inhibitors (SSRI) have been proven safe and effective for the treatment of PMDD. Suppression of ovulation using hormonal therapies is an alternative approach to treating PMDD when SSRIs or second-line psychotropic agents are ineffective. Herbal and vitamin supplementation, and complementary and alternative medicine have been evaluated for use in PMS/PMDD. - Type - Chapter - Information - Menstrual Problems for the MRCOG and Beyond , pp. 139 - 146Publisher: Cambridge University PressPrint publication year: 2014 Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service. - Premenstrual syndrome - Book: Menstrual Problems for the MRCOG and Beyond - Online publication: 05 June 2014 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox. - Premenstrual syndrome - Book: Menstrual Problems for the MRCOG and Beyond - Online publication: 05 June 2014 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive. - Premenstrual syndrome - Book: Menstrual Problems for the MRCOG and Beyond - Online publication: 05 June 2014

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