Premenstrual Syndrome

Assess suicidality, self-harm, psychosis, mania, intoxication, and interpersonal safety at the first visit. Severe cyclic dysphoria can include suicide attempts or overdose; acute safety risk requires immediate psychiatric and emergency assessment rather than waiting for prospective cycle charting. PubMedPubMedNavigating Unique Diagnostic and Therapeutic Challenges in Premenstrual Dysphoric Disorder: A Case Report

Ask the patient to identify the first symptomatic day, peak day, menses onset, symptom resolution, and the least symptomatic interval for each cycle. PMS and PMDD require recurrent luteal-phase symptoms that remit shortly after menses begins, with at least one symptom-free week; symptoms occurring throughout the cycle do not establish a core premenstrual disorder. BMJ+2BMJPremenstrual syndrome and dysphoric disorderPubMedEmotion regulation in Premenstrual Dysphoric Disorder and Premenstrual Syndrome: a systematic reviewPubMedPremenstrual Dysphoric Disorder - StatPearls - NCBI Bookshelf

Record impairment separately from symptom count: work or school performance, parenting, partner conflict, social withdrawal, and health-care use can establish clinical significance. PMDD requires clinically significant distress or interference with occupational, social, or relationship functioning. PubMed+1PubMedEmotion regulation in Premenstrual Dysphoric Disorder and Premenstrual Syndrome: a systematic reviewPubMedPremenstrual dysphoric disorder: burden of illness and ... - PMC

Use the Daily Record of Severity of Problems (DRSP) or another prospective daily rating instrument for at least two symptomatic menstrual cycles. The DRSP reflects PMDD diagnostic features, captures impairment, and is used extensively in clinical practice and PMDD trials. PubMed+3PubMedNavigating Unique Diagnostic and Therapeutic Challenges in Premenstrual Dysphoric Disorder: A Case ReportPubMedTowards a consensus on diagnostic criteria, measurement ...PubMedPremenstrual Dysphoric Disorder - StatPearls - NCBI BookshelfPubMedPremenstrual Dysphoric Disorder (Formerly ... - NCBI

For PMDD, document at least 5 of 11 DSM symptoms during the premenstrual phase, with at least one core affective symptom: depressed mood, anxiety, affective lability, or irritability/anger. Symptoms must remit with the follicular phase and cause clinically significant distress or functional impairment. PubMed+1PubMedEmotion regulation in Premenstrual Dysphoric Disorder and Premenstrual Syndrome: a systematic reviewPubMedPremenstrual dysphoric disorder: burden of illness and ... - PMC

PMS is clinically meaningful when repetitive luteal symptoms and impairment are documented but the full PMDD symptom pattern is not met. Do not equate physical symptoms alone with PMDD; diagnosis depends on symptom timing, follicular remission, affective symptom requirements, and impact. BMJ+2BMJPremenstrual syndrome and dysphoric disorderPubMedEmotion regulation in Premenstrual Dysphoric Disorder and Premenstrual Syndrome: a systematic reviewPubMedPremenstrual dysphoric disorder: burden of illness and ... - PMC

PMS and PMDD are diagnoses of exclusion. A focused menstrual, psychiatric, medication, and medical history plus prospective charting is the central diagnostic workup; evaluate depression and anxiety disorders, menstrual migraine, and mastalgia when their symptoms occur beyond the premenstrual interval or have independent clinical features. BMJ+2BMJPremenstrual syndrome and dysphoric disorderWolters KluwerPremenstrual Syndrome, Premenstrual Dysphoric... : Obstetrics & GynecologyPubMedPremenstrual Dysphoric Disorder (Formerly ... - NCBI

Do not use circulating estradiol or progesterone concentrations to confirm PMDD. Available evidence indicates normal ovarian steroid concentrations and hypothalamic-pituitary-ovarian function in affected patients; the clinically relevant discriminator is abnormal symptom sensitivity to normal cyclic hormonal change. Nature+1NatureThe steroid metabolome in women with premenstrual dysphoric disorder during GnRH agonist-induced ovarian suppression: effects of estradiol and progesterone addback | Translational PsychiatryPubMedPremenstrual Dysphoric Disorder - StatPearls - NCBI Bookshelf

When history identifies a noncyclic or progressive condition, order disease-specific testing rather than broad hormonal panels. Examples include pregnancy testing when pregnancy is possible, targeted assessment for a primary depressive or anxiety disorder when symptoms persist during the follicular phase, and focused neurologic or breast evaluation when migraine or mastalgia is not limited to the premenstrual interval. Wolters Kluwer+2Wolters KluwerPremenstrual Syndrome, Premenstrual Dysphoric... : Obstetrics & GynecologyPubMedPremenstrual Dysphoric Disorder - StatPearls - NCBI BookshelfPubMedPremenstrual Dysphoric Disorder (Formerly ... - NCBI

For mild-to-moderate PMS, begin with exercise and behavioral interventions, then reassess against prospectively recorded symptoms and function. Exercise and luteal-phase SSRI therapy have been recommended as first-line approaches in guidance summarized from the Royal College of Obstetricians and Gynaecologists. BMJBMJRecording and treatment of premenstrual syndrome in UK ...

For PMDD or severe PMS with predominant affective symptoms and functional impairment, offer an SSRI. SSRIs have the strongest evidence of benefit and improve psychological symptoms, irritability, and functional impairment; their rapid clinical effect permits continuous, luteal-phase, or symptom-duration dosing. Wolters KluwerWolters KluwerEvaluation and management of premenstrual... : Current Opinion in Pediatrics

For planned intermittent dosing, start the SSRI 7-14 days before expected menses and continue for 3 days after menses begins. For irregular cycles or patients unable to predict menses reliably, start on the first day of PMDD symptoms and continue until symptoms improve with menses onset. Wolters KluwerWolters KluwerEvaluation and management of premenstrual... : Current Opinion in Pediatrics

When contraception is desired or an SSRI is not preferred, discuss a combined oral contraceptive, particularly a drospirenone-containing formulation, because combined oral contraceptives may reduce premenstrual symptoms and drospirenone-containing products can improve PMDD. acpjournalsacpjournalsContraception | Annals of Internal Medicine Treatment selection should account for contraceptive eligibility and the patient's prior response to hormonal methods.

At each follow-up, review daily ratings for late-luteal symptom reduction, return of a low follicular baseline, and improvement in work, school, parenting, social, or relationship function. The DRSP includes impairment assessment and is appropriate for tracking response as well as establishing the initial diagnosis. PubMedPubMedTowards a consensus on diagnostic criteria, measurement ...

If an intervention improves luteal symptoms but clinically important symptoms remain during the follicular phase, reassess for a coexisting depressive, anxiety, migraine, breast-pain, or other condition rather than escalating PMS-specific treatment alone. Wolters Kluwer+1Wolters KluwerPremenstrual Syndrome, Premenstrual Dysphoric... : Obstetrics & GynecologyPubMedPremenstrual Dysphoric Disorder (Formerly ... - NCBI

Escalate to gynecology or psychiatry for refractory severe symptoms, diagnostic uncertainty, substantial baseline psychiatric disease, safety concerns, or consideration of ovarian suppression. Life-threatening symptoms warrant immediate action rather than completion of a diagnostic diary. PubMed+2PubMedNavigating Unique Diagnostic and Therapeutic Challenges in Premenstrual Dysphoric Disorder: A Case ReportPubMedTowards a consensus on diagnostic criteria, measurement ...Wolters KluwerPremenstrual Syndrome, Premenstrual Dysphoric... : Obstetrics & Gynecology