The epidemiology and management of premenstrual symptoms in the community

Introduction Most women of reproductive age experience premenstrual symptoms before menstruation. Community-based research investigating the prevalence and management of problematic premenstrual symptoms (the premenstrual syndrome or 'PMS') is sparse, especially in the United Kingdom. This study aimed to assess the epidemiology and management of premenstrual symptoms in the community, and identify factors associated with symptom experiences. Methods A systematic review was conducted to identify population-based studies reporting PMS prevalence. In 2014 and 2015 a postal questionnaire was sent to 3,534 women aged 18-50, registered with 20 Scottish general practices. Results Twenty-six population-based studies were included in the systematic review. These reported widely differing prevalences, depending on the definitions of PMS used. The corrected response rate from the survey was 32.1%. Over 95% of women experienced at least one symptom in the previous 12 months. The most frequent moderate to severe symptoms were abdominal cramps: 44.0%; abdominal bloating: 40.9%; irritability: 40.7%; fatigue or lack of energy: 37.6%; and mood swings: 36.8%. The criteria for premenstrual dysphoric disorder (PMDD) and moderate to severe PMS were met by 4.4% and 8.3% of women, respectively; 53.1% reported experiencing PMS, with 10.7% rating this as severe to extreme. Common management strategies used included over-the-counter medication; heat application; exercise; and relaxation or rest. Lifestyle and psychological strategies were more frequently reported than prescribed treatments. The most common associations with different symptom experiences (i.e. moderate to severe PMS/PMDD, self-identified minimal/mild PMS, and self-identified moderate to extreme PMS) related to smoking, self-assessed general health and self-reported current illness/condition. Illness perceptions related to emotional representations and consequences were associated with each of the symptom experiences examined. Current use of most management strategies, a wish for more support from different sources and frequent contact with healthcare professionals were associated with PMS/PMDD and self-identified moderate to extreme PMS.