<prompt> Which of the following modalities have shown best result for premenstrual syndrome?SSRIProgesteroneOestrogenAnxiolyties  <response>: Ans. is a, i.e. SSRIRef: Williams Gynae 1sted, p300; Jeffcoate 7thed, p629; Novaks 15thed, p371,312; Leon speroff 8thed, p578; John Hopkins manual of obs and gynae 4thed, p462Premenstrual disorders: Frequently women of reproductive age experience symptoms during the late luteal phase of their menstrual cycle, and collectively these complaints are termed, premenstrual syndrome PMS or premenstrual dysphoric disorder PMDD It is mostly seen in women aged to 30-45 yearsTreatment of PMS:Conservative measuresInhibition of ovulationMedications directed at symptoms Elimination of caffeine from diet Smoking cessation Counselling, emotional support Low-fat, high-fiber diet and essential fatty acids in diet. Regular exercise Adequate sleep Stress reduction Oral contraceptives especially drospirenone containing GnRH agonist For fluid retention: diuretics For pain: Prostaglandin synthetase For mastalgia: evening primrose oil and pyridoxine For anxietydepression: SSRI like fluoxetine preferred Tricyclic antidepressants can also be usedChoice of treatment in PMSAmongst all the drugs used-SSRIs have shown the best resultsFor premenstrual dysphoric disorder, selective serotonin re uptake inhibitor SSRIS proved effective in clinical trials.Ref: Novak 15thed, p312Women who meet strict criteria for diagnosis of PMS or PMDD, including socioeconomic dysfunction, are candidates for treatment with an SSR1 fluoxetine, sertraline, paroxetine, verlaflexine, administered daily or only during the luteal phase Ref: Leon speroff 8thed, p578SSRIs are the most effective pharmacologic treatment for moderate to severe PMS and PMDDRef: John hopkins manual ofobs and gynae 4thed, p462Remember: The most significant side effect of SSRI is sexual dysfunction including decreased libido and anorgasmia. 