Premenstrual syndrome and dysphoric disorder

Last reviewed: 21 Apr 2022
Last updated: 01 Nov 2019

Summary

Definition

History and exam

Key diagnostic 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 flashes
Other diagnostic factors

Risk factors

  • postpubescent and premenopausal women
  • family history
  • mood disorders
  • cigarette smoking
  • white women
  • sexual abuse and/or trauma
More risk factors

Diagnostic investigations

1st investigations to order

  • symptom diary
More 1st investigations to order

Investigations to consider

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

Treatment algorithm

ONGOING

mild PMS

moderate to severe PMS or PMDD

Contributors

Authors

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

UK

Adjunct Associate Professor

Robert Wood Johnson Medical School

Rutgers University

New Brunswick

NJ

Disclosures

MR declares that she has no competing interests.

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

Professor Margaret Rees, Dr Nancy A. Phillips, and Dr Gloria Bachmann would like to gratefully acknowledge Dr Desiree Lie, the previous contributor to this topic. DL declares that she has 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
    • Generalized anxiety disorder
    More Differentials
  • Guidelines

    • Management of premenstrual syndrome
    • ISPMD consensus on the treatment of premenstrual dysphoric disorder (PMDD)
    More Guidelines
  • Patient leaflets

    Premenstrual syndrome

    More Patient leaflets
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