18.    A 30-year-old para 2 gravida 2 woman presents to the gynecology clinic saying that she has premenstrual syndrome (PMS).                              

a)        What is the commonest reported psychological symptom of PMS?

           Irritability.

b)         What are the two most common physical symptoms of PMS? 

            1.    Abdominal bloating.

             2.    Breast tenderness.

c)         How do you make the diagnosis? 

            Make a menstrual symptom diary. 

d)         What relieves PMS physiologically?

            Onset of menstruation.

e)        Name five treatments.

            1.    Explanation and reassurance.

            2.    Relaxation techniques.

            3.    Combined oral contraception.

            4.    NSAIDs.

            5.    Pyridoxine.

            6.    Bromocriptine.