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Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder

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


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) [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 2017. | This topic last updated: Feb 10, 2016.
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