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Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder

Authors
Kimberly A Yonkers, MD
Robert F Casper, MD
Section Editors
Robert L Barbieri, MD
William F Crowley, Jr, MD
Deputy Editor
Kathryn A Martin, MD

INTRODUCTION

The premenstrual syndrome (PMS) is characterized by the presence of both physical and behavioral (including affective) symptoms that occur repetitively in the second half of the menstrual cycle and interfere with some aspects of the woman's life. The American Psychiatric Association (APA) defines premenstrual dysphoric disorder (PMDD) as a severe form of PMS in which symptoms of anger, irritability, and internal tension are prominent. (See 'Evaluation' below.)

This topic will review the clinical manifestations and diagnosis of PMS and PMDD. The epidemiology, pathogenesis, and treatment of this disorder are discussed separately. (See "Epidemiology and pathogenesis of premenstrual syndrome and premenstrual dysphoric disorder" and "Treatment of premenstrual syndrome and premenstrual dysphoric disorder".)

DEFINITIONS

Most women of reproductive age experience one or more mild emotional or physical symptoms for one to two days before the onset of menses (figure 1). These symptoms, such as breast soreness and bloating, are mild, do not cause severe distress or functional impairment, and are not considered to represent premenstrual syndrome (PMS) [1].

In contrast, clinically significant PMS is defined by the American College of Obstetricians and Gynecologists (ACOG) as at least one symptom associated with “economic or social dysfunction” that occurs during the five days before the onset of menses and is present in at least three consecutive menstrual cycles (figure 1). Symptoms may be affective (eg, angry outbursts, depression) or physical (eg, breast pain and bloating) (table 1). (See 'Evaluation' below.)

Premenstrual dysphoric disorder (PMDD) is the most severe form and is described below. (See 'PMDD' below.)

                         

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Literature review current through: Nov 2016. | This topic last updated: Wed Feb 10 00:00:00 GMT+00:00 2016.
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References
Top
  1. Yonkers KA, O'Brien PM, Eriksson E. Premenstrual syndrome. Lancet 2008; 371:1200.
  2. O'Brien PM, Bäckström T, Brown C, et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health 2011; 14:13.
  3. Hartlage SA, Freels S, Gotman N, Yonkers K. Criteria for premenstrual dysphoric disorder: secondary analyses of relevant data sets. Arch Gen Psychiatry 2012; 69:300.
  4. Halbreich U, Backstrom T, Eriksson E, et al. Clinical diagnostic criteria for premenstrual syndrome and guidelines for their quantification for research studies. Gynecol Endocrinol 2007; 23:123.
  5. Freeman EW, Halberstadt SM, Rickels K, et al. Core symptoms that discriminate premenstrual syndrome. J Womens Health (Larchmt) 2011; 20:29.
  6. Pearlstein T, Yonkers KA, Fayyad R, Gillespie JA. Pretreatment pattern of symptom expression in premenstrual dysphoric disorder. J Affect Disord 2005; 85:275.
  7. Mortola JF, Girton L, Beck L, Yen SS. Diagnosis of premenstrual syndrome by a simple, prospective, and reliable instrument: the calendar of premenstrual experiences. Obstet Gynecol 1990; 76:302.
  8. Casper RF, Graves GR, Reid RL. Objective measurement of hot flushes associated with the premenstrual syndrome. Fertil Steril 1987; 47:341.
  9. Dean BB, Borenstein JE, Knight K, Yonkers K. Evaluating the criteria used for identification of PMS. J Womens Health (Larchmt) 2006; 15:546.
  10. Borenstein JE, Dean BB, Leifke E, et al. Differences in symptom scores and health outcomes in premenstrual syndrome. J Womens Health (Larchmt) 2007; 16:1139.
  11. Heinemann LA, Minh TD, Filonenko A, Uhl-Hochgräber K. Explorative evaluation of the impact of severe premenstrual disorders on work absenteeism and productivity. Womens Health Issues 2010; 20:58.
  12. Pilver CE, Libby DJ, Hoff RA. Premenstrual dysphoric disorder as a correlate of suicidal ideation, plans, and attempts among a nationally representative sample. Soc Psychiatry Psychiatr Epidemiol 2013; 48:437.
  13. Rapkin AJ, Winer SA. Premenstrual syndrome and premenstrual dysphoric disorder: quality of life and burden of illness. Expert Rev Pharmacoecon Outcomes Res 2009; 9:157.
  14. Cohen LS, Soares CN, Otto MW, et al. Prevalence and predictors of premenstrual dysphoric disorder (PMDD) in older premenopausal women. The Harvard Study of Moods and Cycles. J Affect Disord 2002; 70:125.
  15. Freeman EW, Sammel MD, Rinaudo PJ, Sheng L. Premenstrual syndrome as a predictor of menopausal symptoms. Obstet Gynecol 2004; 103:960.
  16. Di Giulio G, Reissing ED. Premenstrual dysphoric disorder: prevalence, diagnostic considerations, and controversies. J Psychosom Obstet Gynaecol 2006; 27:201.
  17. Andersch B, Abrahamsson L, Wendestam C, et al. Hormone profile in premenstrual tension: effects of bromocriptine and diuretics. Clin Endocrinol (Oxf) 1979; 11:657.
  18. Taylor JW. Plasma progesterone, oestradiol 17 beta and premenstrual symptoms. Acta Psychiatr Scand 1979; 60:76.
  19. Mortola JF. Issues in the diagnosis and research of premenstrual syndrome. Clin Obstet Gynecol 1992; 35:587.
  20. Endicott J, Nee J, Harrison W. Daily Record of Severity of Problems (DRSP): reliability and validity. Arch Womens Ment Health 2006; 9:41.
  21. Rapkin AJ, Chang LC, Reading AE. Comparison of retrospective and prospective assessment of premenstrual symptoms. Psychol Rep 1988; 62:55.
  22. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
  23. Hay AG, Bancroft J, Johnstone EC. Affective symptoms in women attending a menopause clinic. Br J Psychiatry 1994; 164:513.
  24. Gallant SJ, Popiel DA, Hoffman DM, et al. Using daily ratings to confirm premenstrual syndrome/late luteal phase dysphoric disorder. Part I. Effects of demand characteristics and expectations. Psychosom Med 1992; 54:149.
  25. Tobin MB, Schmidt PJ, Rubinow DR. Reported alcohol use in women with premenstrual syndrome. Am J Psychiatry 1994; 151:1503.
  26. McLeod DR, Foster GV, Hoehn-Saric R, et al. Family history of alcoholism in women with generalized anxiety disorder who have premenstrual syndrome: patient reports of premenstrual alcohol consumption and symptoms of anxiety. Alcohol Clin Exp Res 1994; 18:664.