Comparison between the synergistic use of oral contraceptives and fluoxetine vs fluoxetine alone in the management of premenstrual syndrome

210 women with premenstrual syndrome (PMS) will be prospectively diagnosed. Diagnosis will be done using the daily record of severity of problems (DRSP), women will be asked to fill the diary for 2 months. Only women with 30% increase in the DRSP score in the week before menses in both months will be diagnosed as having PMS. Women will be randomly divided into 3 groups, group 1 will receive combined oral contraceptives (gynera) tablets, 75mg Gestodene and 0.03mg ethinylestradiol per tablet orally once daily for 21 days starting starting from the second day of menstruation in addition to the continuous use of fluoxetine (Prozac) oral tablets 50mg daily, the second group will receive continuous fluoxetine oral tablets 50mg daily and the third group will receive a placebo daily. Treatment will be continued for 3 months in all the groups. Monitoring of adherence to treatment will be monitored by asking the patients to return the empty tablet strips.Symptoms of premenstrual syndrome will be assesses 3 months after starting the treatment