Premenstrual Syndrome and Premenstrual Dysphoric Disorder

Deb Rink

Definition

• Premenstrual Syndrome (PMS)– having mild to severe physical and/or emotional

symptoms that typically occur about 5-11 days before a woman starts her monthly menstrual cycle, and these symptoms stop shortly after mences begins 3–6

• Premenstrual Dysphoric Disorder (PMDD)– a condition in which a woman has severe depression

symptoms not otherwise specified and emotional and cognitive behavioral symptoms before menstruation that interfere with daily function. 3–6

Ocurrance

• Up to 80% of all women experience PMS symptoms1

• Up to 10% of all women report the more severe symptoms of PMDD1,3,7

Signs and Symptoms• depressed moods, • anxiety,• lability, • irritability,

– irritability has been shown to have no discrimination between normal and PMS participants in research and is reported by most women 2

• decreased interest in usual activities,• concentration difficulties, • lack of energy, • change in appetite, • sleep changes, • feeling overwhelmed, and • physical symptoms such as bloating, breast tenderness, headaches, joint pain,

weight gain, and cramps 1–7

More Symptoms

• mood swings, • feeling out of control, • feeling hopeless, • possible suicidal thoughts, and • panic attacks 2–4,6

Diagnosis

• PMDD– A woman must display 1 of 4 core symptoms (irritability,

anxiety, dysphoria, or lability), – have at least 5 of the 11 typical symptoms listed above, and– have had the symptoms in most of her cycles for the last 12

months in order to be diagnosed with PMDD – These symptoms must have interfered with social or

occupational function 1 • PMS

– PMS has very similar symptoms, – does not require an emotional symptom, – nor is there a need to confirm daily functional impairment 1

Differential Diagnosis

• Medical conditions, such as thyroid disease, etc.

• Psychological disorders• Social disorders1–4

Note: PMS/PMDD are very difficult to diagnose

Treatment

• Healthy lifestyle• Supplemental vitamins and minerals = vitamin

B6, calcium, magnesium, and vitamin E • Herbal remedies = evening primrose oil and

chaste tree berry • SSRI’s for most severe cases1,3,7

References

• • 1. Steiner M. Premenstrual syndrome and premenstrual dysphoric disorder: guidelines for

management. J Psychiatry Neurosci. 2000;25(5):459.• 2. Freeman EW, Halberstadt SM, Rickels K, Legler JM, Lin H, Sammel MD. Core Symptoms

That Discriminate Premenstrual Syndrome. J Womens Heal 15409996. 2011;20(1):29–35.• 3. Bhatia SC, Bhatia SK. Diagnosis and treatment of premenstrual dysphoric disorder. Am

Fam Physician. 2002;66(7):1239–1249.• 4. Firoozi R, Kafi M, Salehi I, Shirmohammadi M. The Relationship between Severity of

Premenstrual Syndrome and Psychiatric Symptoms. Iran J Psychiatry. 2012;7(1):36–40.• 5. Orsal O, Tozun M, Unsal A. Relationship between Premenstrual syndrome and

depressive symptoms among nursing students. HealthMed. 2013;7(2):508–515.• 6. Wang Y, Lin S, Chen R, Benita W-M. Pattern of moderate-to-severe symptoms of

premenstrual syndrome in a selected hospital in China. J Obstet Gynaecol Res. 2012;38(1):302–309.

• 7. Board ADAME. Premenstrual dysphoric disorder. 2012. Available at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004461/. Accessed October 28, 2013.