1. Premenstrual Syndrome and Premenstrual Dysphoric Disorder Deb Rink

2. Definition • Premenstrual Syndrome (PMS) • having mild to severe physical and/or emotional symptoms that typically occur about 5-11 days before a woman starts her monthly menstrual cycle, and these symptoms stop shortly after mences begins 3–6 • Premenstrual Dysphoric Disorder (PMDD) • a condition in which a woman has severe depression symptoms not otherwise specified and emotional and cognitive behavioral symptoms before menstruation that interfere with daily function.3–6

3. Ocurrance • Up to 80% of all women experience PMS symptoms1 • Up to 10% of all women report the more severe symptoms of PMDD1,3,7

4. Signs and Symptoms • depressed moods, • anxiety, • lability, • irritability, • irritability has been shown to have no discrimination between normal and PMS participants in research and is reported by most women2 • decreased interest in usual activities, • concentration difficulties, • lack of energy, • change in appetite, • sleep changes, • feeling overwhelmed, and • physical symptoms such as bloating, breast tenderness, headaches, joint pain, weight gain, and cramps1–7

5. More Symptoms • mood swings, • feeling out of control, • feeling hopeless, • possible suicidal thoughts, and • panic attacks2–4,6

6. Diagnosis • PMDD • A woman must display 1 of 4 core symptoms (irritability, anxiety, dysphoria, or lability), • have at least 5 of the 11 typical symptoms listed above, and • have had the symptoms in most of her cycles for the last 12 months in order to be diagnosed with PMDD • These symptoms must have interfered with social or occupational function 1 • PMS • PMS has very similar symptoms, • does not require an emotional symptom, • nor is there a need to confirm daily functional impairment1

7. Differential Diagnosis • Medical conditions, such as thyroid disease, etc. • Psychological disorders • Social disorders1–4 Note: PMS/PMDD are very difficult to diagnose

8. Treatment • Healthy lifestyle • Supplemental vitamins and minerals=vitamin B6, calcium, magnesium, and vitamin E • Herbal remedies = evening primrose oil and chaste tree berry • SSRI’s for most severe cases1,3,7

9. References • 1. Steiner M. Premenstrual syndrome and premenstrual dysphoric disorder: guidelines for management. J Psychiatry Neurosci. 2000;25(5):459. • 2. Freeman EW, Halberstadt SM, Rickels K, Legler JM, Lin H, Sammel MD. Core Symptoms That Discriminate Premenstrual Syndrome. J Womens Heal 15409996. 2011;20(1):29–35. • 3. Bhatia SC, Bhatia SK. Diagnosis and treatment of premenstrual dysphoric disorder. Am Fam Physician. 2002;66(7):1239–1249. • 4. Firoozi R, Kafi M, Salehi I, Shirmohammadi M. The Relationship between Severity of Premenstrual Syndrome and Psychiatric Symptoms. Iran J Psychiatry. 2012;7(1):36–40. • 5. Orsal O, Tozun M, Unsal A. Relationship between Premenstrual syndrome and depressive symptoms among nursing students. HealthMed. 2013;7(2):508–515. • 6. Wang Y, Lin S, Chen R, Benita W-M. Pattern of moderate-to-severe symptoms of premenstrual syndrome in a selected hospital in China. J ObstetGynaecol Res. 2012;38(1):302–309. • 7. Board ADAME. Premenstrual dysphoric disorder. 2012. Available at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004461/. Accessed October 28, 2013.