In this Seminar, we searched Medline (1950ā2006) with the subject heading āpremenstrual syndromeā and keywords of āpremenstrual syndromeā and āpremenstrual dysphoric disorderā. Of the 3138 publications that we identified, we selected the most up-to-date publications as well as key reports in the field relevant to the phenomenology, pathophysiology, and treatment of moderate to severe PMS and PMDD. To ensure that important publications were reviewed, we searched the reference lists of
SeminarPremenstrual syndrome
Introduction
Most women of reproductive age have one or more emotional or physical symptom in the premenstrual phase of the menstrual cycle. The symptoms are mild, but 5ā8% have moderate to severe symptoms that are associated with substantial distress or functional impairment. In early medical reports about this issue, clinically significant premenstrual symptoms were named premenstrual tension (PMT)1 or premenstrual syndrome (PMS).2 The WHO International Classification of Diseases (ICD) includes āpremenstrual tension syndromeā under the heading āDiseases of the Genitourinary Tractā. However, like PMS and PMT, this description is not useful for the purpose of clinical diagnostics, drug labelling, or research, since it is not defined by specific criteria, and does not specify severity.
Section snippets
Diagnosis
In the mid-1980s, a multidisciplinary US National Institutes of Health consensus conference on PMS proposed criteria that were adopted by the Diagnostic and Statistical Manual III (DSM III)3 to define the severe form of this condition. Originally entitled ālate luteal phase dysphoric disorderā, it was later renamed āpremenstrual dysphoric disorderā (PMDD). The diagnosis of PMDD stipulates (1) the presence of at least five luteal-phase symptoms (panel), at least one of which must be a mood
Prevalence
Most studies on the prevalence of premenstrual complaints are based on retrospective reports which, by their nature, can introduce recall bias.6, 7, 8, 9, 10, 11, 12 However, the findings of these studies are consistent with those from the few epidemiological studies that used prospective symptom ratings.13, 14 Findings of prospective and retrospective studies suggest that 5ā8% of women with hormonal cycles have moderate to severe symptoms. However, some studies suggest that up to 20% of all
Pattern of symptom expression
The length of symptom expression varies between a few days and 2 weeks (figure 1). Symptoms often worsen substantially 6 days before, and peak at about 2 days before, menses start.16, 17 Anger and irritability are the most severe complaints and start slightly earlier than other symptoms (figure 2).16 It is not uncommon for symptoms to linger into the next menstrual cycle16, 17, 18 but, by definition, there must be a symptom-free interval before ovulation. Typically, women have the same set of
Aetiology and pathophysiology
Since most women of reproductive age report at least mild premenstrual symptoms, a certain degree of discomfort during the luteal phase should probably be considered physiological rather than pathological. In evolutionary terms,29 luteal mood changes could be remnants of the oestrous cycle-related fluctuations in behaviour shown by lower species with the original purpose of promoting reproduction: sexual receptivity being increased and aggression decreased when oestrogen is high before
Treatment
Before pharmacological treatment is considered, the medical history of women with presumed PMS should be investigated for conditions such as depression, dysthymic disorder, anxiety disorders, and hypothyroidism. Given the possible links between PMS and sexual abuse, as well as with post-traumatic stress disorder,60 a history that assesses the presence of these factors, as well as domestic violence, should be obtained. Some individuals with anxiety and mood disorders, including PMS, attempt to
Conclusions
There is substantial empirical research to support the existence of a severe premenstrual disorder causing marked functional impairment. Severe PMS is consistently reported by about 5% of all women of fertile age. The management of PMS is complex. At the outset it is important to establish a precise diagnosis and not rely on the patient's own diagnosis. It is mandatory to separate PMS/PMDD from other diagnoses, particularly depression and anxiety disorders, premenstrual exacerbation of another
Search strategy and selection criteria
References (180)
- et al.
Pretreatment pattern of symptom expression in premenstrual dsyphoric disorder
J Affect Disord
(2005) - et al.
Timing and severity of symptoms associated with the menstrual cycle in a community-based sample in the Midwestern United States
Psychiatr Res
(2005) - et al.
Severity of premenstrual symptoms in a health maintenance organization population
Obstet Gynecol
(2002) - et al.
Prevalence of axis I and axis II disorders in women with late luteal phase dysphoric disorder
J Affect Disord
(1990) - et al.
Lifetime prevalence of psychiatric disorders in women with perimenstrual difficulties
J Affect Disord
(1986) - et al.
An evolutionary theory of premenstrual tension
Lancet
(1974) - et al.
Menstrual cycle and social behavior in vervet monkeys
Psychoneuroendocrinology
(1995) - et al.
The serotonin reuptake inhibitor fluoxetine reduces sex steroid-related aggression in female rats: an animal model of premenstrual irritability?
Neuropsychopharmacology
(2001) - et al.
Estrous cycle fluctuations in aggressiveness of house mice
Horm Behav
(1977) - et al.
The effect of hysterectomy and bilateral oophorectomy in women with severe premenstrual syndrome
Am J Obstet Gynecol
(1990)
Lasting response to ovariectomy in severe intractable premenstrual syndrome
Am J Obstet Gynecol
Thyroid axis function during the menstrual cycle in women with premenstrual syndrome
Psychoneuroendocrinol
Chronobiological basis of female-specific mood disorders
Neuropsychopharmacology
A naturalistic study of paroxetine in premenstrual syndrome: efficacy and side effects during ten cycles of treatment
Eur Neuropsychopharmacology
A regional study of sex differences in rat brain serotonin
Prog Neuro-Psychopharmacol Biol Psychiatry
Estrogen selectively increases tryptophan hydroxylase-2 mRNA expression in distinct subregions of rat midbrain raphe nucleus: association between gene expression and anxiety behavior in the open field
Biol Psychiatry
Estrogen-serotonin interactions: implications for affective regulation
Biol Psychiatry
Diverse actions of ovarian steroids in the serotonin neural system
Front Neuroendocrinol
A placebo-controlled clinical trial of L-tryptophan in premenstrual dysphoria
Biol Psychiatry
Acute tryptophan depletion aggravates premenstrual syndrome
J Affect Disord
Mood changes correlate to changes in brain serotonin precursor trapping in women with premenstrual dysphoria
Psychiatry Res
Reduced platelet tritium-labeled imipramine binding sites in women with premenstrual syndrome
Am J Obstet Gynecol
Neuroendocrine response to an intravenous L-tryptophan challenge in women with premenstrual syndrome
Fertil Steril
Serotonergic dysfunction in women with pure premenstrual dysphoric disorder: is the fenfluramine challenge test still relevant
Psychiatry Res
Serotonin receptors, buspirone, and premenstrual syndrome
Lancet
Serotonin transporter gene polymorphisms and platelet [3H] paroxetine binding in premenstrual dysphoria
Psychoneuroendocrinology
Reduced benzodiazepine sensitivity in patients with premenstrual syndrome: a pilot study
Psychoneuroendocrinol
Progesterone metabolite allopregnanolone in women with premenstrual syndrome
Obstet Gynecol
Allopregnanolone levels and reactivity to mental stress in premenstrual dysphoric disorder
Biol Psychiatry
Citalopram increases pregnanolone sensitivity in patients with premenstrual syndrome: an open trial
Psychoneuroendocrinology
Premenstrual syndrome: weight, abdominal swelling, and perceived body image
Am J Obstet Gynecol
The hormonal causes of premenstrual tension
Arch Neurol Psychiatry
The premenstrual syndrome
BMJ
Diagnostic and statistical manual of mental disorders-DSM-III
Diagnostic and statistical manual of mental disorders-DSM-IV
ACOG practice bulletin: premenstrual syndrome
Int J Gynecol Obstet
Epidemiology of premenstrual symptoms in a nonclinical sampleāI: Prevalence, natural history and help-seeking behavior
J Repro Med
Biological, social, and behavioral factors associated with premenstrual syndrome
Arch Fam Med
The epidemiology of premenstrual symptoms in a population based sample of 2650 urban women
J Clin Epidemiol
Prevalence of perimenstrual symptoms
Am J Public Health
Premenstrual complaints. Prevalence of premenstrual symptoms in a Swedish urban population
J Psychosom Obstet Gynaecol
The epidemiology of perimenstrual psychological symptoms
Acta Psychiatr Scand
Prevalence, incidence and stability of premenstrual dysphoric disorder in the community
Psychol Med
Late luteal phase dysphoric disorder in young women
Am J Psychiatry
Characteristics of women with premenstrual dysphoric disorder (PMDD) who did or did not report history of depression: a preliminary report from the Harvard study of moods and cycles
J Women's Health Gend Based Med
Heath and economic impact of the premenstrual syndrome
J Reprod Med
Premenstrual syndrome: Evidence for symptom stability across cycles
Am J Psychiatry
Diagnosis and treatment of premenstrual dysphoric disorder: an update
Int Clin Psychopharmacol
Relationship of dysphoric premenstrual changes to depressive disorder
Acta Psychiatrica Scandinavica
Premenstrual symptoms and perimenopausal depression
Am J Psychiatry
Cited by (392)
Network structure of complex interactions of premenstrual syndrome and influencing factors in young adult women
2024, Journal of Affective DisordersInvestigating the mechanisms of Xiaoyaosan on premenstrual dysphoric disorder using metabolomics technology
2024, Pharmacological Research - Modern Chinese MedicineCharacterization of pathogenic factors for premenstrual dysphoric disorder using machine learning algorithms in rats
2023, Molecular and Cellular Endocrinology