Premenstrual syndrome and premenstrual dysphoric disorder

Chapter 32 PREMENSTRUAL SYNDROME AND PREMENSTRUAL DYSPHORIC DISORDER



Theodore O’Connell


Premenstrual syndrome (PMS) is characterized by the cyclic recurrence of symptoms during the luteal phase of the menstrual cycle. Premenstrual dysphoric disorder (PMDD) is a severe form of PMS. Of women of reproductive age, 80% have physical changes, such as breast tenderness or abdominal bloating, that are associated with menstruation; of these women, 20% to 40% experience symptoms of PMS, and 2% to 10% report severe disruption of their daily activities. The American College of Obstetrics and Gynecology (ACOG) recommends the PMS diagnostic criteria developed by the University of California at San Diego and the National Institute of Mental Health. These criteria are presented in Box 32-1.



Box 32-1. Diagnostic Criteria for Premenstrual Syndrome



National Institute of Mental Health


Both of the following criteria must be present:



• A 30% increase in the intensity of symptoms of premenstrual syndrome (measured on a standardized instrument) from cycle days 5 to 10 in comparison with the 6-day interval before the onset of menses


• Documentation of these changes in a daily symptom diary for at least two consecutive cycles



University of California at San Diego


At least one of the following affective and somatic symptoms occurs during the 5 days before menses in each of the three previous cycles:



• Affective symptoms: depression, angry outbursts, irritability, anxiety, confusion, social withdrawal


• Somatic symptoms: breast tenderness, abdominal bloating, headache, swelling of extremities


• Symptoms relieved from days 4 through 13 of the menstrual cycle


From American College of Obstetrics and Gynecology Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists. Number 15, April 2000. Premenstrual syndrome. Obstet Gynecol 2000;95:1-9; and Kessel B: Premenstrual syndrome. Advances in diagnosis and treatment. Obstet Gynecol Clin North Am 2000;27:625-39.


PMDD is characterized by various combinations of marked mood swings, depressed mood, irritability, and anxiety, which may be accompanied by physical symptoms. These symptoms occur exclusively during the luteal phase of the menstrual cycle and generally resolve within 2 to 3 days after the onset of menses. The symptoms cause substantial impairment of personal functioning, generally more in social than occupational domains. A symptom-free period during the follicular phase of the menstrual cycle is essential in differentiating PMDD from preexisting anxiety or mood disorders.


Features of PMDD and depressive disorders overlap considerably. A family history of depression is common in women diagnosed with moderate to severe PMS. Despite the overlap between PMDD and depressive disorders, many patients with PMDD do not have depressive symptoms; therefore, PMDD should not be considered simply a variant of depressive disorder. The diagnostic criteria for PMDD from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, are presented in Box 32-2.



Box 32-2. Research Criteria for Premenstrual Dysphoric Disorder




A. In most menstrual cycles during the past year, five (or more) of the following symptoms were present for most of the time during the last week of the luteal phase, began to remit within a few days after the onset of the follicular phase, and were absent in the week after menses, with as least one of the symptoms being 1, 2, 3, or 4:


1. Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts

2. Marked anxiety, tension, or feelings of being “keyed up” or “on edge”

3. Marked affective lability (e.g., feeling suddenly sad or tearful or increased sensitivity to rejection)

4. Persistent and marked anger or irritability or increased interpersonal conflicts

5. Decreased interest in usual activities (e.g., work, school, friends, hobbies)

6. Subjective sense of difficulty in concentrating

7. Lethargy, easy fatigability, or marked lack of energy

8. Marked change in appetite, overeating, or specific food cravings

9. Hypersomnia or insomnia

10. A subjective sense of being overwhelmed or out of control

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Jun 4, 2016 | Posted by in GYNECOLOGY | Comments Off on Premenstrual syndrome and premenstrual dysphoric disorder

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