Epidemiology and pathogenesis 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) and the more severe variant of premenstrual dysphoric disorder (PMDD), also called late luteal phase dysphoric disorder in previous versions of the Diagnostic and Statistical Manual (DSM), are characterized by the presence of physical and/or behavioral symptoms that occur repetitively in the second half of the menstrual cycle and often the first few days of menses. The symptoms of PMS or PMDD are severe enough that they interfere with some aspects of the woman's life (eg, family or other social relations, work in or outside the home, etc). The most common physical manifestation is abdominal bloating [1,2]. Breast tenderness and headaches are also common (table 1). (See "Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder".)
The diagnosis of PMDD is discussed in greater detail elsewhere. The clinical manifestations, diagnosis, and treatment of PMS/PMDD are discussed separately. (See "Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder" and "Treatment of premenstrual syndrome and premenstrual dysphoric disorder".)
Premenstrual dysphoric disorder (PMDD), as defined by the American Psychiatric Association (APA) Diagnostic and Statistical Manual, Fifth Edition (DSM-5), can be differentiated from premenstrual syndrome (PMS) by the presence of at least one affective symptom, such as mood swings, irritability, and/or depression . Premenstrual symptoms are common, affecting up to 75 percent of women with regular menstrual cycles. Clinically significant PMS occurs in 3 to 8 percent of women [1,4], while PMDD affects about 2 percent of women.
The prevalence of PMS in the population has been overestimated because of the failure to apply strict inclusion criteria. Estimates as high as 80 percent have been reported, based upon the inclusion of women who have some form of premenstrual mood or physical symptoms . The problem with these estimates is that they do not consider whether symptoms are moderate to severe or if they interfere with functioning. When one applies strict inclusion criteria for PMDD, estimates are around 2 percent, as illustrated by three community studies that used prospective ratings to determine the diagnosis [6-8]. (See "Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder", section on 'Evaluation'.)
PMS has been described in diverse cultural settings, even among women who are not generally aware of the disorder. As an example, similar rates of the disorder have been reported in Mediterranean countries, the Middle East, Iceland, Kenya, and New Zealand [9-12]. In an international survey of 7226 women in Europe, South America, and Asia, the frequency of PMS symptoms was similar across countries and regions, but women in some countries, such as Pakistan, were less familiar with the term PMS when compared with European women .
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