Data gathering
- Red flags – none
- Others – alcohol, smoking, stress, menstrual history (LMP, cycle length, bleeding length, menorrhagia, dysmenorrhoea), smears, obstetric history
Clinical management
- Investigations
- Symptom diary
- Explanation
- common 1/20 women, no test, cause is not known but ovulation with release of the egg appears to trigger symptoms
- Treatment
- Lifestyle – exercise, diet, stop smoking, reduce alcohol, reduce stress
- Medications – SSRI (second half of cycle), COCP
- Psychology – CBT
- PIL
- Follow-up / Safety net – if simple measures explored, can refer to gynae