Premenstrual Dysphoric Disorder

Introduction

• Description: Premenstrual syndrome (PMS) and the more severe variant of premenstrual dysphoric disorder (PMDD) involve physical and emotional symptoms that are characterized by their relationship to menses. Symptoms are confined to a period of not more than 5 days before the onset of menstrual flow with complete resolution at or soon after the end of menstrual flow. Symptoms must persist over three or more consecutive menstrual cycles.

• Prevalence: Reproductive age (25%–85%); lifestyle is affected in 5%–10% and 2%–5% meet strict criteria for PMDD. Some authors think that the true prevalence is less if strict diagnostic criteria are applied.

• Predominant Age: Reproductive; most commonly 30s and 40s.

• Genetics: Family tendency, preliminary evidence suggests that PMDD is associated with variations in ESR1 (estrogen receptor alpha gene).

Etiology and Pathogenesis

• Causes: The physiologic foundations of PMS, PMDD, and premenstrual magnification (PMM) remain to be established. The most promising research into a cause of PMS has been in the areas of β-endorphins and serotonin, γ-aminobutyric acid (GABA) and the autonomic nervous system.

• Risk Factors: Some suggestion of a link to smoking, low educational attainment, traumatic events, or anxiety disorders.

Signs and Symptoms

Physical or emotional symptoms confined to a period of not more than 5 days before the onset of menstrual flow with complete resolution at or soon after the end of menstrual flow. More than 150 different signs and symptoms have been described under the rubric of PMS (the character of the symptoms is not important, only the timing of their appearance). Symptoms that are present at all times but worsen before menses or those that appear at irregular intervals do not meet the criteria for PMS; they should be classified as PMM. The diagnosis of PMDD requires the presence of at least one affective symptom (mood swings, irritability, anger, difficulty concentrating, depression).

Diagnostic Approach