PREMENSTRUAL SYNDROME

doi:10.1016/S0193-953X(05)70024-1

Psychiatric Clinics of North America

Volume 21, Issue 3, 1 September 1998, Pages 577-590

https://doi.org/10.1016/S0193-953X(05)70024-1 Get rights and content

Emotional symptoms relating to the menstrual cycle have been described for centuries, and the term “premenstrual tension” appeared in the literature in 1931 describing such symptoms.²⁰ A considerable number of research studies about the prevalence, origin, and treatment of premenstrual symptoms have been conducted in the past 2 decades. Both the medical and lay communities now have increased awareness of the morbidity associated with the cyclic, disabling premenstrual symptoms in many women during the reproductive years; however, the presentation of premenstrual symptoms in a woman requires careful evaluation. In particular, women with premenstrual symptoms often have concurrent psychiatric or medical illnesses that warrant treatment.

Section snippets

DEFINITION AND PREVALENCE OF PREMENSTRUAL SYNDROME

Premenstrual syndrome (PMS) can be defined as emotional, behavioral, and physical symptoms that occur in the premenstrual (luteal) phase of the menstrual cycle, with resolution after menses. In mild cases, nondisabling symptoms may occur for a day or two before menses. In severe cases, debilitating symptoms may begin around ovulation and continue for 2 weeks through the first few days of menses. Reviews of epidemiologic studies of retrospective reports of premenstrual symptoms indicate that as

PREMENSTRUAL DYSPHORIC DISORDER

The premenstrual dysphoric disorder (PMDD) criteria in the appendix of DSM-IV¹ (Table 1) is a diagnostic classification for women who have significant functional impairment caused by moderate to severe premenstrual symptoms. The PMDD criteria slightly modify the late luteal phase dysphoric disorder (LLPDD) criteria in DSM-III-R², and women who meet the PMDD criteria are coded on axis I as Depressive Disorder Not Otherwise Specified. The PMDD criteria require confirmation of the diagnosis by

DIFFERENTIAL DIAGNOSIS

The differential diagnosis of PMS is important and can be problematic for the clinician encountering a woman with premenstrual symptoms. Commonly used daily rating forms have been described above, but a clinician can review any prospective daily charting of a woman's most troublesome premenstrual symptoms. It is important to note the presence or absence of follicular symptomatology to rule out a chronic disorder. Clinical evaluations during the follicular and luteal phases also help identify

SUMMARY

The advances in the careful screening and diagnosis of women with PMS has led to the ability to conduct epidemiologic, etiologic, and treatment studies in well-defined samples of women. Prospective symptom charting, scoring methods, and careful clinical psychiatric and medical evaluation are necessary to rule out concurrent psychiatric and medical disorders. Studies of women with PMDD have suggested several promising pharmacologic treatment options. Whether these treatment options are also

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Cited by (52)

Anger in women with premenstrual dysphoric disorder: Its relations with premenstrual dysphoric disorder and sociodemographic and clinical variables
2013, Comprehensive Psychiatry
Citation Excerpt :
In some women, these symptoms may be severe to impair work capacity, social and family relations, and school performance [1–3]. This clinical presentation, defined as Premenstrual Stress Syndrome by Frank in 1931, was renamed as (1994) “Premenstrual Dysphoric Disorder (PMDD)” in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and classified in the group of depressive disorders not otherwise specified [4–6]. For the diagnosis of PMDD, at least five of 11 symptoms mentioned in DSM-IV-TR should be present; functionality should be disturbed and symptoms should have been existing at least for two consecutive months.
The aim of the present study was to investigate anger and anger levels in women meeting the criteria of Premenstrual Dysphoric Disorder and to determine the relation between anger levels and the severity of PMDD and other variables.
50 women meeting the criteria of Premenstrual Dysphoric Disorder and 50 healthy controls were included in the study. Sociodemographic, familial and reproductive period characteristics of the women participating in the study were recorded. All subjects were administered the State–Trait Anger Scale and Premenstrual Syndrom Scale scales.
A significant difference was found between the Premenstrual Dysphoric Disorder group and the healthy control group in terms of Premenstrual Syndrom Scale scores and anger sub scores. When the state trait anger scale scores were examined, it was seen that subscles had higher scores compared to healthy women. In Premenstrual Dysphoric Disorder group; there was a positive correlation between Premenstrual Syndrom Scale scores and trait anger, anger-in and anger control scores.
Anger appears to be an important problem that makes life more difficult for subjects with Premenstrual Dysphoric Disorder. Wide-scale further studies focused on anger and its relation with Premenstrual Dysphoric Disorder are needed to develop ways of coping with anger in Premenstrual Dysphoric Disorder.
Anxiety sensitivity, the menstrual cycle, and panic disorder: A putative neuroendocrine and psychological interaction
2011, Clinical Psychology Review
Citation Excerpt :
Commonly reported premenstrual changes include acne, constipation or diarrhea, fatigue, fluid retention, increased sex drive, headaches, insomnia, joint or muscle aches and pains, sweet or salty food cravings, affect lability, anxiety, bursts of energy, feeling of loss of control, irritability, poor concentration, sadness, and tension (Bloch et al., 1997; Chrisler & Caplan, 2002; Freeman, 2003; Logue & Moos, 1986). Approximately 50–80% of women report that they experience at least some symptoms during the premenstrual phase (Halbreich et al., 2003; Logue & Moos, 1986; Pearlstein & Stone, 1998; Wittchen et al., 2002). Prospective tracking of symptoms across three consecutive menstrual cycles among healthy women who did not meet criteria for PMDD revealed that 50.8% of the sample reported a 66% or greater increase in physical symptom severity from the follicular to the premenstrual phase (Gonda et al., 2008).
The 2:1 female-to-male sex difference in the prevalence of panic disorder (PD) suggests that there is a sex-specific vulnerability involved in the etiology and/or maintenance of this disorder. The purpose of this paper is to present a new conceptual model, which emphasizes the interaction between a cognitive vulnerability for PD, anxiety sensitivity, and the effects of progesterone and its metabolite, allopregnanolone, on behavioral and physiological responses to stress during the premenstrual phase. This interaction is proposed to be a potential sex-specific pathway that may initiate and/or maintain panic and anxiety symptoms in women. This review paper presents preliminary evidence from both the human and animal literatures to support this new model. Specific topics reviewed include: psychopathology related to the menstrual cycle, anxiety sensitivity and its relationship to the menstrual cycle, PMS, and PMDD, anxiety-modulating effects of progesterone and its neuroactive metabolite, allopregnanolone, and how results from the neuroendocrine literature relate to psychopathology or symptoms associated with the menstrual cycle.
Sleep and Menstrual-Related Disorders
2008, Sleep Medicine Clinics
Citation Excerpt :
The definition of PMS varies in the literature [2] but generally is characterized by “emotional, behavioral, and physical symptoms that occur in the premenstrual phase of the menstrual cycle, with resolution after menses” [3].
There are few studies of sleep in menstrual-related disorders. Preliminary evidence indicates subtle differences in sleep and circadian regulation in women with severe premenstrual syndrome, and increased subjective sleepiness in the premenstrual phase. Symptoms may be relieved in some sufferers with partial sleep deprivation. Primary dysmenorrhea occurs in approximately 25% of women who self-report sleep disturbance, a finding confirmed by laboratory-based study of sleep in these women. Menstrual cycle-related sleep disturbance appears to be highly prevalent; more research is needed to investigate the role of sleep in the etiology of menstrual disorders and the role of sleep manipulation in their treatment.
An overview of premenstrual syndrome
2007, Journal de Gynecologie Obstetrique et Biologie de la Reproduction
L'objectif de ce travail est de faire le point au vu des données de la littérature sur : la place nosographique, la définition, l'épidémiologie, le diagnostic, l'évaluation, les hypothèses étiologiques et les traitements du syndrome prémenstruel.
Revue exhaustive de la littérature après consultation de la banque de données bibliographiques Medline, par les mots clés : premenstrual ; syndrome.
Le syndrome prémenstruel (SPM) est un ensemble de symptômes somatiques, affectifs et comportementaux apparaissant avant les règles et disparaissant avec elles. Cet ensemble symptomatique toucherait approximativement 75 % des femmes en âge de procréer. La spécificité de ce syndrome tient à sa cyclicité, et à son intensité suffisamment sévère pour altérer significativement le fonctionnement personnel, social et professionnel. Son diagnostic est confirmé par une autoévaluation idéalement prospective pendant au moins deux cycles symptomatiques, mettant en évidence : une variété de manifestations physiques et psychologiques ; la répétition des manifestations apparaissant avant les menstruations et disparaissant complètement à la survenue des règles ; la constatation d'un intervalle asymptomatique d'au moins une semaine dans la période suivant les règles ; une sévérité suffisante pour altérer le fonctionnement global. Plusieurs hypothèses biologiques et psychosociales ont été avancées et débattues. Le consensus actuel renvoie à une vulnérabilité aux variations hormonales du cycle menstruel. Les traitements de la symptomatologie prémenstruelle sont variés, d'indications peu nettes, d'efficacité peu établie. Seuls le carbonate de calcium et les inhibiteurs sélectifs de la recapture de la sérotonine (ISRS) reposent sur des données scientifiques solides.
Le syndrome prémenstruel garde encore plusieurs inconnues en rapport avec sa prévalence, son étiologie et son traitement.
Premenstrual syndrome (PMS) is a recurrent disorder that occurs in the luteal phase of the menstrual cycle. It is characterized by intense physical, psychological, and behavioral changes that interrupt interpersonal relationships and disrupt the lives of affected women. Premenstrual syndrome is believed to affect 75% of women of childbearing age. Because no tests can confirm PMS, the diagnosis should be made on the basis of a patient-completed daily symptom calendar and the exclusion of other medical disorders. PMS symptoms occur during the luteal phase of the menstrual cycle and remit with the onset of menstruation or shortly afterward. The aetiology of PMS is still unknown uncertain, but are likely associated with aberrant responses to normal hormonal fluctuations during the menstrual cycle. A wide range of therapeutic interventions has been tested in the treatment of premenstrual symptoms. Most non-pharmacological interventions that have been proven efficacious require a series of interventions. If non-medical approaches are ineffective, drug therapy may be appropriate. Several pharmaceutics agents have been shown to relieve symptoms. Calcium carbonate and selective serotonin reuptake inhibitors have demonstrated excellent efficacy.
What is the desired menstrual frequency of women without menstruation-related symptoms?
2006, Contraception
This study aimed to investigate the desired menstrual frequency of subjects without menstruation-related symptoms.
The study included 270 women of reproductive age. Women with menstrual headache, dysmenorrhea, hypermenorrhea and/or premenstrual syndrome were excluded. The study subjects completed a standardized questionnaire.
Of the women, 75.6% declared that menstrual periods interfere with their sexual life, 28.8% preferred not having their menstrual period when at work and 48.4% reported that menstrual periods interfere with practicing sports. Given the choice, 28.5% of the women would desire amenorrhea and 27.8% would prefer a reduction in the frequency of menstrual periods. Of the 152 women desiring to reduce menstrual frequency, 73.0% declared that they would accept to use a drug to reduce menstrual frequency.
Over 50% of women without menstruation-related symptoms would like to lessen the frequency of menstrual periods and about 50% of them would desire amenorrhea.
Premenstrual dysphoric disorder: Burden of illness and treatment update
2008, Journal of Psychiatry and Neuroscience
Citation Excerpt :
A recent study reported that 64% of the first 1500 women with MDD enrolled in the STAR*D study retrospectively reported premenstrual exacerbation of their depressive symptoms.39 Dysthymia, MDD, panic disorder and generalized anxiety disorder are the most common axis I psychiatric disorders that may be concurrent and exacerbated premenstrually, with less clear evidence for bipolar disorder, posttraumatic stress disorder, social phobia, eating disorders and substance abuse.12,18,40–43 Personality disorders do not have elevated prevalence in women with PMDD,19 but women with PMDD and a personality disorder may demonstrate premenstrual phase amplification of personality dysfunction.44
Five percent of menstruating women have severe premenstrual symptoms and impairment of functioning defined as premenstrual dysphoric disorder (PMDD). Clinically significant premenstrual symptoms occur in at least an additional 20% of menstruating women. The diagnosis of PMDD should be confirmed by prospective symptom charting over 2 menstrual cycles to confirm the timing of the symptoms and to rule out other diagnoses. The burden of illness of PMDD includes disruption of parenting and partner relationships and decreased productivity in work roles. In addition, women with PMDD have increased use of health care services such as clinician visits and increased use of prescription medications and over-the-counter preparations. The etiology of PMDD is multifactorial. In particular, dysregulation of the serotonin and allopregnanolone systems is implicated. Several effective treatment options exist, including serotonergic antidepressant medications and an oral contraceptive that contains ethinyl estradiol and drosperinone. In addition, other hormones that suppress ovulation, anxiolytics, cognitive therapy, chasteberry and calcium may be helpful.
Cinq pour cent des femmes menstruées ont des symptômes prémenstruels sévères et une incapacité du fonctionnement appelée trouble dysphorique prémenstruel (TDPM). Au moins 20 % de femmes menstruées de plus ont des symptômes prémenstruels cliniquement significatifs. Il faut confirmer le diagnostic de TDPM en suivant les symptômes de façon prospective au cours de deux cycles menstruels afin de confirmer le moment de l’apparition des symptômes et d’exclure d’autres diagnostics. Le fardeau morbide imposé par le TDPM comprend la perturbation des relations avec les enfants et le partenaire et une baisse de productivité au travail. Les femmes atteintes de TDPM ont en outre recours davantage aux services de santé comme les visites aux cliniciens et prennent davantage de médicaments d’ordonnance et en vente libre. L’étiologie du TDPM est multifactorielle. La dysrégulation des systèmes de la sérotonine et de l’allopregnanolone en particulier est mise en cause. Il existe plus d’un traitement efficace possible, y compris des antidépresseurs sérotoninergiques et un contraceptif oral qui contient de l’éthinyloestradiol et de la drosperinone. D’autres hormones qui bloquent l’ovulation, des anxiolytiques, la thérapie cognitive, le gattilier (Vitex agnus castus) et le calcium peuvent en outre aider.

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: Address reprint requests to: Teri Pearlstein, MD, Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906

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PREMENSTRUAL SYNDROME

Section snippets

DEFINITION AND PREVALENCE OF PREMENSTRUAL SYNDROME

PREMENSTRUAL DYSPHORIC DISORDER

DIFFERENTIAL DIAGNOSIS

SUMMARY

J Affect Disord

J Affect Disord

J Affect Disord

J Affect Disord

J Anxiety Disord

Psychoneuroendocrinology

Biol Psychiatry

Psychiatry Res

J Anxiety Disord

J Subst Abuse

J Affect Disord

Am J Obstet Gynecol

J Affect Disord

Biol Psychiatry

Psychosomatics

J Clin Epidemiol

Psychiatry Res

Psychosomatics

J Anxiety Disord

J Affect Disord

Am J Obstet Gynecol

Diagnostic and Statistical Manual for Mental Disorders

Diagnostic and Statistical Manual for Mental Disorders

Menstrual cycle phase-related changes in appetite in patients with premenstrual syndrome and in control subjects

Am J Psychiatry

Agoraphobia with panic attacks

Arch Gen Psychiatry

Clinical trials of treatments of premenstrual syndrome: Entry criteria and scales for measuring treatment outcomes

Br J Obstet Gynaecol

Medical history in women with premenstrual syndrome

J Psychosom Obstet Gynecol

Ramifications of late luteal phase dysphoric disorder diagnosis

Iss Mental Health Nurs

Premenstrual mood disorder and psychiatric illness

Am J Psychiatry

How common is catamenial epilepsy?

Epilepsia

Late luteal phase dysphoric disorder: Relationship to personality disorders

J Personal Disord

Differential diagnoses and comorbidity

Daily Rating of Severity of Problems Form

The serotonin reuptake inhibitor paroxetine is superior to the noradrenaline reuptake inhibitor maprotiline in the treatment of premenstrual syndrome

Neuropsychopharmacology

Lactate infusion induces panic attacks in patients with premenstrual syndrome

Psychosom Med

The hormonal causes of premenstrual tension

Arch Neurol Psychiatry

Prevalence and risk factors of premenstrual syndrome

Clin Adv Psychiatr Disord

Relationships between age and symptom severity among women seeking medical treatment for premenstrual symptoms

Psychol Med

Personality factors in women with premenstrual syndrome

Psychosom Med

A design for studying the DSM-IV research criteria of premenstrual dysphoric disorder

J Psychosom Obstet Gynecol

Premenstrual exacerbation of binge eating in bulimia

Am J Psychiatry

Treatment of premenstrual dysphoric symptoms in depressed women

J Am Med Wom Assoc

“Ovarian asthma”: Fact or fancy?

J Ky Med Assoc

Rethinking the label: Who benefits from the PMS construct?

Women Health

Premenstrual dysphoric disorders: A diversified cluster of vulnerability traits to depression

Acta Psychiatr Scand