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 symptoms 1 Up to 10% of all women report the more severe symptoms of PMDD 1,3,7

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 women 2 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 cramps 1–7

5. More Symptoms mood swings, feeling out of control, feeling hopeless, possible suicidal thoughts, and panic attacks 2–4,6

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 impairment 1

7. Differential Diagnosis Medical conditions, such as thyroid disease, etc. Psychological disorders Social disorders 1–4 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 cases 1,3,7

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 Obstet Gynaecol 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.