Premenstrual syndrome and dysphoric disorder

Last reviewed: April 2018

Last updated: December 2017

Summary

Premenstrual syndrome is characterised by cyclical physical and behavioural symptoms occurring in the luteal phase of the normal menstrual cycle.

Premenstrual dysphoric disorder is a more severe variant that includes at least 1 affective symptom. Affective symptoms such as anger, irritability, and/or internal tension occur during the second half of the menstrual cycle, and sometimes extend into the first few days of menses.

PMS is a diagnosis of exclusion. Physical symptoms are abdominal bloating (most common), breast tenderness, and headaches.

Treatment comprises lifestyle modification, pharmacological interventions, and, in severe cases, surgery.

Definition

Premenstrual syndrome (PMS) is characterised by cyclical physical and behavioural symptoms occurring in the luteal phase of the menstrual cycle (the time period between ovulation and onset of menstruation). Premenstrual dysphoric disorder (PMDD) is a more severe variant that includes at least 1 affective symptom. DSM-5 criteria require 5 or more physical and behavioural symptoms from a pre-specified list to be recorded using a diary. [1] The University of California, San Diego criteria recommend prospective reports by women during several consecutive cycles, with the exclusion of psychiatric conditions. [2]

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

Full details

Other diagnostic factors

increased appetite
forgetfulness and difficulty concentrating
other subjective symptoms
insomnia or hypersomnia
GI upset
heart palpitations
hot flushes

Full details

Risk factors

post-pubescent and pre-menopausal women
family history
mood disorders

Full details

Diagnostic investigations

1st investigations to order

symptom diary

Full details

Investigations to consider

TFTs
LH levels
FSH levels
depression screening

Full details

Treatment algorithm

ONGOING

Contributors

Authors VIEW ALL 

Margaret Rees, MA, DPhil, FRCOG

Editor in Chief

Maturitas

President

European Menopause and Andropause Society

Reader Emeritus in Reproductive Medicine

University of Oxford

Women's Centre, John Radcliffe Hospital

Oxford

Visiting Professor

Faculty of Medicine

University of Glasgow

Glasgow

Adjunct Associate Professor

Robert Wood Johnson Medical School

Rutgers University

New Brunswick

Disclosures

MR declares that she has no competing interests.

Acknowledgements

Professor Margaret Rees would like to gratefully acknowledge Dr Desiree Lie, the previous contributor to this monograph. DL declares that she has no competing interests.

Peer reviewers VIEW ALL 

Julianne Toohey, MD

Obstetrician-Gynecologist

Department of Obstetrics and Gynecology

University of California Irvine Medical Center

Orange

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

Disclosures

CH declares that she has no competing interests.

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Premenstrual syndrome and dysphoric disorder

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Treatment algorithm

predominantly behavioural symptoms and/or PMDD

predominantly somatic symptoms

mixed somatic and behavioural symptoms

Contributors

Authors VIEW ALL 

Margaret Rees, MA, DPhil, FRCOG

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Julianne Toohey, MD

Disclosures

Carol Henshaw, MB ChB, MD

Disclosures

Differentials

Guidelines

Patient leaflets

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