Most books on premenstrual syndromes published in the past 5 years have been self-help books, a testament to the importance women place on their need to manage these symptoms. Anne Figart, a sociologist writing in 2005, noted that publicising and legitimising premenstrual syndrome (PMS) over the years has had a positive effect in increasing women's sense of control over their symptoms. However, she and others writing from a feminist perspective, also argue that the label PMS allows women to make excuses for their behaviour and permits doctors and scientists to exert control over them which might lead to bias and discrimination. In parallel with this debate, the scientific world has seen enormous advances in understanding the aetiology of PMS and premenstrual dysphoric disorder (PMDD), and the evidence base for treatment has grown.
A central theme of this book is the pulling together of a variety of perceptions of the nature of the disorders and their management from scientists, gynaecologists, psychiatrists and complementary medicine practitioners from the UK, Europe and the USA. The only missing voices in this text are those of women with PMS or PMDD whose attitudes to, and beliefs about, the available treatments are important.
Practice differs in several respects between disciplines and countries, sometimes following the evidence base but elsewhere departing from it. Even in the UK, some of drugs with the strongest evidence base are not licensed for treating PMS or PMDD, whereas some of those without demonstrated efficacy are licensed.
The book begins with a historical overview followed by a chapter examining the debate around these diagnoses and outlining the diagnostic criteria used in clinical settings and research. Elias Eriksson then reviews the role of serotonergic dysfunction in the pathophysiology of PMS. The other chapters on pathophysiology (ovarian steroids and endocrine studies, and γ–aminobutyric acid with reference to neuroimagaing studies) are found later in the book, with genetics the subject of the penultimate chapter. It would seem more logical to group the chapters relating to aetiology together and follow them with those relating to epidemiology, then assessment and treatment.
There are updates for psychiatrists who have forgotten the physiology of the menstrual cycle and gynaecologists who lack knowledge of neurotransmitters. Three chapters focus on epidemiology, comorbidity with other psychiatric conditions, and clinical presentation and course. Others discuss hormonal therapies, psychotropics (antidepressants with a paragraph on anxiolytics), ovarian cycle suppression and complementary therapies. Clinical assessment, evaluation and management are addressed. Nowhere else will you find such an up-to-date collection of scientific thought and evidence and I would recommend it as an essential reference for anyone working with women of reproductive potential.
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