Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder
- Kimberly A Yonkers, MD
Kimberly A Yonkers, MD
- Professor of Psychiatry and Obstetrics and Gynecology
- Yale University
- Robert F Casper, MD
Robert F Casper, MD
- Professor, Division of Reproductive Sciences
- University of Toronto, Canada
- Senior Investigator
- Lunenfeld-Tanenbaum Research Institute
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- William F Crowley, Jr, MD
William F Crowley, Jr, MD
- Section Editor — Female Reproductive Endocrinology
- Daniel K Podolsky Professor of Medicine
- Harvard Medical School
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".)
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) .
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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- CLINICAL MANIFESTATIONS
- Timing of symptoms
- Most common symptoms
- Impact on quality of life
- Suicide risk
- Natural history
- Physical exam
- Laboratory findings
- General approach
- Prospective monitoring with self-rating scale
- DIAGNOSTIC CRITERIA
- - Available diagnostic criteria
- DSM-5 criteria
- Women without menstruation
- DIFFERENTIAL DIAGNOSIS
- Mood and anxiety disorders
- Menopausal transition
- Thyroid disorders
- Substance abuse
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS