Diagnosis and Management of Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)- A Synopsis
Four out of ten women experience premenstrual syndrome (PMS), which describe a cluster of emotional and physical symptoms that occurs during the luteal phase and then abates as menstruation begins.
Cyclical changes in sex steroid production are suggested to provoke these symptoms although it remains unclear how these physiological changes are associated with PMS. [Yonkers et al 2008]
- Approximately 85% of women of reproductive age will experience some level of discomfort during the luteal phase. In one French study of 2800 women, 12% met the criteria for PMS. [Hofmeister S & Bodden S., 2016]
- Between 3-9% of women however will experience a more severe constellation of symptoms known as premenstrual dysphoric disorder (PMDD).
PMDD presents as an array of intense cognitive and affective symptoms during the pre-menstruum in females of child-bearing age. [Epperson et al 2012]
PMDD is underdiagnosed often due to it being undifferentiated from PMS; however, PMDD is more intense with greater physical and psychological symptoms that greatly impairs functioning and quality of life. [Malvika and Supriya 2019]
Both PMS and PMDD are part of core premenstrual disorders. (Core PMD).
Variant Premenstrual Disorders (Variant PMD) are PMD’s that do not meet criteria for core PMDs. [Green L et al., 2017]
- Symptoms of an underlying psychological or somatic disorder significantly worsen premenstrually e.g. diabetes, depression, epilepsy, asthma and migraine.
- Symptoms arise from continued ovarian activity even though menstruation has been suppressed
3. Progestogen-induced PMDs:
- Exogenous progestogens present in hormone replacement therapy (HRT) and the combined oral contraceptive (COC) pill.
4. PMDs with absent menstruation:
- Women who still have a functioning ovarian cycle, but for reasons such as hysterectomy, endometrial ablation or the levonorgestrel-releasing intrauterine system (LNG-IUS) they do not menstruate.
Sacher, J., Zsido, R. G., Barth, C., Zientek, F., Rullmann, M., Luthardt, J., … & Sabri, O. (2023). Increase in serotonin transporter binding in patients with premenstrual dysphoric disorder across the menstrual cycle: a case-control longitudinal neuroreceptor ligand PET imaging study. Biological Psychiatry.
Agha-Hosseini, M., Kashani, L., Aleyaseen, A., Ghoreishi, A., Rahmanpour, H. A. L. E. H., Zarrinara, A. R., & Akhondzadeh, S. (2008). Crocus sativus L.(saffron) in the treatment of premenstrual syndrome: a double‐blind, randomised and placebo‐controlled trial. BJOG: An International Journal of Obstetrics & Gynaecology, 115(4), 515-519.