A 28 year old woman, suffers from emotional liability and depression, about 10 days prior to her menses. She repos that once she begins to bleed, she feels back to normal. She also gives a history of premenstrual fatigue, bloating and breast tenderness. What would be the best treatment for the patient?

Fluoxetine is a selective serotonin Reuptake Inhibitor (SSRI) and SSRIs have shown the greatest efficiency in PMS treatment. Premenstrual syndrome (PMS), also called Premenstrual Tension (PMT), is a symptom complex, recognised primarily by cyclic changes, associated with ovulatory cycles. It occurs 7 to 14 days prior to menstruation and spontaneously resolves after menses. It always occurs in the luteal phase of the cycle. Symptoms include: Pain: Headache, breastpain, abdominal cramps, muscle stiffness, backache and generalise body ache. Water retention: Breast volume increase, bloating and weight gain. Behavioural changes: Low performance, difficulty in concentration, irritability, depression, forgetfulness, low judgement, anxiety, loneliness, feeling like crying, hostility, increased appetite and cravings and sleeplessness. Autonomic changes: Dizziness, faintness, nausea, vomiting and hot flushes Treatment: Psychosomatic symptoms: SSRIs, Vitamin B1, B6 and E Breast pain: Danazol, Bromocriptine and GnRH analogues Pelvic pain and bloatedness: OCP and Mirena IUCD General measures: Excercise, relaxation and hobbies like Meditation and Yoga Ref: Shaw&;s textbook of Gynaecology 17th edition PGno: 127