Premenstrual syndrome and dysphoric disorder

Last reviewed: 1 Sep 2022
Last updated: 16 Aug 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • abdominal bloating
  • fatigue
  • breast tenderness
  • headaches
  • depressed mood, irritability, and internal tension
  • labile mood
  • adverse effect on life
More key diagnostic factors

Other diagnostic factors

  • increased appetite
  • forgetfulness and difficulty concentrating
  • other subjective symptoms
  • insomnia or hypersomnia
  • gastrointestinal upset
  • heart palpitations
  • hot flushes
Other diagnostic factors

Risk factors

  • post-pubescent and premenopausal women
  • family history
  • mood disorders
  • cigarette smoking
  • white women
  • sexual abuse and/or trauma
  • alcohol consumption
More risk factors

Diagnostic investigations

1st investigations to order

  • prospective symptom diary
More 1st investigations to order

Investigations to consider

  • thyroid function tests
  • follicle-stimulating hormone levels
  • depression screening
  • FBC
More investigations to consider

Treatment algorithm

ONGOING

mild PMS

moderate to severe PMS or PMDD

Contributors

Authors

Nancy A. Phillips, MD

Associate Professor

Department of Obstetrics, Gynecology and Reproductive Sciences

Rutgers Robert Wood Johnson Medical School

New Brunswick

NJ

Disclosures

NAP declares that she has no competing interests.

Gloria Bachmann, MD

Professor

Department of Obstetrics, Gynecology and Reproductive Sciences

Rutgers Robert Wood Johnson Medical School

New Brunswick

NJ

Disclosures

GB declares that she has no competing interests.

Acknowledgements

Dr Nancy A. Phillips and Dr Gloria Bachmann would like to gratefully acknowledge Professor Margaret Rees and Dr Desiree Lie, the previous contributor to this topic.

Disclosures

MR and DL declare that they have no competing interests.

Peer reviewers

Julianne Toohey, MD

Obstetrician-Gynecologist

Department of Obstetrics and Gynecology

University of California Irvine Medical Center

Orange

CA

Disclosures

JT declares that she has no competing interests.

Carol Henshaw, MB ChB, MD

Consultant in Perinatal Mental Health

Liverpool Women's NHS Foundation Trust

Liverpool

UK

Disclosures

CH declares that she has no competing interests.

  • Differentials

    • Depression
    • Thyroid disease
    • Generalised anxiety disorder
    More Differentials
  • Guidelines

    • Management of premenstrual syndrome
    • Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder
    More Guidelines
  • Patient leaflets

    Premenstrual syndrome

    More Patient leaflets
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