Chapter 32 PREMENSTRUAL SYNDROME AND PREMENSTRUAL DYSPHORIC DISORDER
Premenstrual syndrome (PMS) is characterized by the cyclic recurrence of symptoms during the luteal phase of the menstrual cycle. Premenstrual dysphoric disorder (PMDD) is a severe form of PMS. Of women of reproductive age, 80% have physical changes, such as breast tenderness or abdominal bloating, that are associated with menstruation; of these women, 20% to 40% experience symptoms of PMS, and 2% to 10% report severe disruption of their daily activities. The American College of Obstetrics and Gynecology (ACOG) recommends the PMS diagnostic criteria developed by the University of California at San Diego and the National Institute of Mental Health. These criteria are presented in Box 32-1.
Box 32-1. Diagnostic Criteria for Premenstrual Syndrome
From American College of Obstetrics and Gynecology Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists. Number 15, April 2000. Premenstrual syndrome. Obstet Gynecol 2000;95:1-9; and Kessel B: Premenstrual syndrome. Advances in diagnosis and treatment. Obstet Gynecol Clin North Am 2000;27:625-39.
Features of PMDD and depressive disorders overlap considerably. A family history of depression is common in women diagnosed with moderate to severe PMS. Despite the overlap between PMDD and depressive disorders, many patients with PMDD do not have depressive symptoms; therefore, PMDD should not be considered simply a variant of depressive disorder. The diagnostic criteria for PMDD from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, are presented in Box 32-2.
Box 32-2. Research Criteria for Premenstrual Dysphoric Disorder
A. In most menstrual cycles during the past year, five (or more) of the following symptoms were present for most of the time during the last week of the luteal phase, began to remit within a few days after the onset of the follicular phase, and were absent in the week after menses, with as least one of the symptoms being 1, 2, 3, or 4:
