Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)
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- Premenstrual syndrome (PMS), a complex of physical and emotional symptoms sufficiently severe to interfere with everyday life, occurs cyclically during the luteal phase of menses.
- Premenstrual dysphoric disorder (PMDD) is a severe form of PMS characterized by severe recurrent depressive and anxiety symptoms, with premenstrual (luteal phase) onset, that remits a few days after the start of menses.
- PMDD is now included as a full diagnostic category in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
- System(s) affected: endocrine/metabolic, nervous, reproductive
- Many women have some physical and psychological symptoms before menses (this is not PMS).
- Premenstrual disorders affect up to 12% of the U.S. population (1). 3–8% of menstruating women have PMDD.
Etiology and Pathophysiology
Not well understood. Leading theories postulate metabolites of progesterone interact with central neurotransmitter receptors (serotonin and γ-aminobutyric acid [GABA]), provoking downstream effects of decreased GABA-mediated inhibition and decreased serotonin levels. Women with PMS/PMDD have similar levels of progesterone but seem to have an increased sensitivity to its metabolites, compared with women without PMS/PMDD.
- Role of genetic predisposition is controversial; however, twin studies do suggest a genetic component.
- Involvement of gene coding for the serotonergic 5HT1A receptor and allelic variants of the estrogen receptor-α gene (ESR1) is suggested.
- Age: usually present in late 20s to mid-30s
- History of mood disorder (major depression, bipolar disorder), anxiety disorder, personality disorder, or substance abuse
- Family history
- Low parity
- Tobacco use
- Psychosocial stressors/history of trauma
- High BMI