Premenstrual syndrome and dysphoric disorder

Premenstrual syndrome (PMS) is characterized by repetitive, cyclical, physical, behavioral, and cognitive symptoms occurring in the luteal phase of the ovulatory menstrual cycle.

Premenstrual dysphoric disorder (PMDD) is a more severe variant of PMS.

PMS and PMDD are diagnoses of exclusion, confirmed by a prospective symptom diary that verifies their repetitive, cyclical nature.

Management options include lifestyle modification, behavioral therapy, pharmacologic interventions, and, in severe refractory cases, induction of a menopausal state.

​PMS is characterized by repetitive, cyclical, physical, and behavioral symptoms occurring in the luteal phase of the ovulatory menstrual cycle (i.e., the time frame between ovulation and onset of menstruation) that interferes with some aspect of the woman's life, causing personal, interpersonal, or functional impairment. PMDD is the more severe form of the disorder and is classified as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.

The International Society for Premenstrual Disorders (ISPMD) recognizes over 150 different psychological, physical, behavioral, and cognitive symptoms that may be associated with premenstrual disorders.[2]Ismaili E, Walsh S, O'Brien PMS, et al; Consensus Group of the International Society for Premenstrual Disorders. Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder. Arch Womens Ment Health. 2016 Dec;19(6):953-8. http://www.ncbi.nlm.nih.gov/pubmed/27378473?tool=bestpractice.com ​ For a diagnosis of PMS/PMDD, symptoms must not be present at other times through the cycle, must cause significant impairment, must not represent an exacerbation of another disorder, and at least one symptom-free week must be evident.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.[2]Ismaili E, Walsh S, O'Brien PMS, et al; Consensus Group of the International Society for Premenstrual Disorders. Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder. Arch Womens Ment Health. 2016 Dec;19(6):953-8. http://www.ncbi.nlm.nih.gov/pubmed/27378473?tool=bestpractice.com [3]American College of Obstetricians and Gynecologists. Guidelines for women's health care: a resource manual. 4th ed. Washington, DC: American College of Obstetricians and Gynecologists; 2014:607-13.​​​​[4]Green LJ, O’Brien PMS, Panay N, et al; Royal College of Obstetricians and Gynaecologists. Management of premenstrual syndrome: green-top guideline no. 48. BJOG. 2017 Feb;124(3):e73-105. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.14260 http://www.ncbi.nlm.nih.gov/pubmed/27900828?tool=bestpractice.com