Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) is a topic covered in the 5-Minute Clinical Consult.

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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.

Risk Factors

  • 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

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