Premenstrual syndrome and premenstrual dysphoric disorder

Published on 10/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 10/03/2015

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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.

PMDD is characterized by various combinations of marked mood swings, depressed mood, irritability, and anxiety, which may be accompanied by physical symptoms. These symptoms occur exclusively during the luteal phase of the menstrual cycle and generally resolve within 2 to 3 days after the onset of menses. The symptoms cause substantial impairment of personal functioning, generally more in social than occupational domains. A symptom-free period during the follicular phase of the menstrual cycle is essential in differentiating PMDD from preexisting anxiety or mood disorders.

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.