Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) Quiz: Ace Your Exams

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19-year-old individual presents to their primary care physician’s office with a one-year history of bloating, breast tenderness, irritability, mood swings, and lethargy that occur in the week before theimenstrual cycle. Once menstruation begins, these symptoms improve, although their periods remain heavy and painful. Past medical history is significant for acne, which has significantly affected their self-esteem. They take loratadine for seasonal allergies and ibuprofen during mensesThe patient does not drink alcohol or use recreational substances. Vital signs are within normal limits. A chaperoned physical examination reveals a normal-sized, non-tender, mobile uterus without adnexal masses. Acne is noted on the patient's cheekschin, and forehead; the remainder of the breast and abdominal examinations are unremarkableLaboratory studies show hemoglobin level of 12.3 g/dLthyroid-stimulating hormone (TSH) level of 2.1 mIU/L, and a negative human chorionic gonadotropin (hCG) test. The patient does not desire pregnancybut they would like a treatment that addresses as many of their symptoms as possible. Which of the following is the best initial treatment for this patient? 

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