Numerous, but heterogeneous studies have been performed about premenstrual 
syndrome, with finally a lack of credibility and interest among practitioners. 
More recently with the diagnosis criteria generalization, psychiatrists were 
more concerned about this syndrome, because of anxiety and mood symptoms 
involved in social impairment and need of medical care. In 1983 in the United 
States, the National Institute of Mental Health conference devoted to this topic 
proposed the first diagnosis criteria, requiring a prospective and daily 
assessment of the symptoms. In 1987, the American Psychiatric Association, in 
the DSM III-R, introduced the Late Luteal Phase Dysphoric Disorder diagnosis 
that became in 1994 in the DSM IV the Premenstrual Dysphoric Disorder, with the 
same diagnosis criteria. In the literature, prevalence rates are very 
heterogeneous according to the diagnosis criteria used and to the populations 
studied. One of the most relevant criteria is the induced impairment, such as 
avoidance of social activities, or search for medical care. Lifetime prevalence 
is thus estimated between 75 and 85% if considering the report of one or several 
symptoms, between 10 and 15% in case of medical care request, and between 2 and 
5% in case of social activities interruption. To distinguish isolated complaints 
from a disabling disorder, self-questionnaires are the best way of assessment in 
a so complex and changing disease. Most of the epidemiological studies found a 
positive correlation between the premenstrual dysphoric symptoms and the 
lifetime major depressive disorder diagnosis. However, recent prospective 
studies failed to find an association between premenstrual syndrome and an 
increased risk of major depression. On the other hand, some studies showed that 
the premenstrual period is a risk period for associated psychiatric disorders 
exacerbations, as the obsessive-compulsive disorder, more severe alcohol intakes 
in case of alcoholism, symptoms increase in schizophrenics, or higher rates of 
suicide attempts. The most widely studied and frequently blamed etiopathogenic 
hypothesis is the serotonin dysregulation. Serotonin is particularly involved in 
expression of irritability and anger, but also in occurrence of depressive 
symptoms and specific food cravings, precisely found in the premenstrual 
dysphoric disorder. Among their different effects, estrogens increase the 
density of serotonin receptors and enhance the sensitivity to serotonin 
agonists. Moreover, some studies found a significantly different response to 
d-fenfluramine, a serotonin agonist, in women with premenstrual dysphoric 
disorder. In psychoanalytical theories the premenstrual syndrome was associated 
to a "femininity complex", to an ambivalent pregnancy desire, and to unconscious 
conflicts relating to sexual preference. In this context, Karen Horney, who took 
a great interest in the premenstrual period, was radically opposed to the 
Freudian theory of feminine sexuality, in particular the negation of the female 
sex. For Karen Homey, the "desire of penis" is more expressive of the woman's 
spite not to share the sexual, but also political, social and cultural benefits 
fallen to men. To understand the premenstrual period feelings it is also 
necessary to take into account the personal history of the woman and the 
psychosocial factors involved, as the social and cultural beliefs, and the 
mother-daughter communication. Medical cares are necessary when symptoms 
constitute a severe and disabling disorder. Among non-psychiatric treatments, 
progesterone was the most widely prescribed treatment, but relating to recent 
performed studies, it failed to prove its efficiency in such an indication. In 
the same way, the efficiency of the contraceptive pill was not demonstrated. The 
most prescribed psychiatric treatments are serotonin re-uptake inhibitors and 
benzodiazepines. First studies showing serotonin re-uptake inhibitors efficiency 
in premenstrual dysphoric disorder were performed in the beginning of the 
nineties, with clomipramine and fluoxetine, and later fluvoxamine, paroxetine, 
sertraline and citalopram. Studies having compared the efficiency of 
antidepressants according to their serotonin activity (paroxetine or sertraline 
versus maprotiline, that is a selective noradrenaline re-uptake inhibitor), 
showed that serotonin re-uptake inhibitors were significantly more efficient on 
all symptoms than maprotiline, that was not more efficient than placebo. Low 
doses of clomipramine (10 to 50 mg per day) seem to be sufficient and it appears 
also preferable to prescribe an intermittent treatment because of a possible 
tolerance effect, susceptible to be warned by phases free of treatment. 
Alprazolam was the most studied benzodiazepine in this indication. Most studies 
were positive, using daily posologies of 0.25 to 4 mg during the 6 days 
preceding the menses, with improvement of irritability, anxiety and depressive 
mood. The general practitioner frequently carries out psychological support, in 
particular in case of mild symptoms without consequences. Nevertheless, 
underestimate a more severe psychological suffering is a risk, firstly because 
there is no systematic interrelationship between the somatic symptoms intensity 
and the psychological distress, and secondly because premenstrual period is a 
special emotionally moment to put in evidence psychological or relational 
disruption. All kinds of psychotherapy can be relevant, even though the training 
of relaxation techniques is particularly suitable in such an indication. In 
conclusion, and in spite of the generalization of the diagnosis criteria in the 
international psychiatric classifications as the DSM, the premenstrual syndrome 
remains a complex and polymorphous disorder. The premenstrual syndrome was 
considered for a long time like a somatic disease, but now the psychiatric 
symptoms severity justifies most often the medical cares. In order to 
distinguish some isolated and mild complaints, of a disabling disorder, the 
standardized prospective auto-assessment is the most relevant method. Finally, 
intermittent prescription of serotonin re-uptake inhibitors appears to be the 
most effective treatment, the previously used hormonal treatments not having 
made proof of their efficiency in such an indication.