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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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Basics

Description

  • 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

Epidemiology

Prevalence
  • 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.

Genetics
  • 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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Citation

Stephens, Mark B., et al., editors. "Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688249/all/Premenstrual_Syndrome__PMS__and_Premenstrual_Dysphoric_Disorder__PMDD_.
Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD). In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688249/all/Premenstrual_Syndrome__PMS__and_Premenstrual_Dysphoric_Disorder__PMDD_. Accessed May 22, 2019.
Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD). (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688249/all/Premenstrual_Syndrome__PMS__and_Premenstrual_Dysphoric_Disorder__PMDD_
Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 May 22]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688249/all/Premenstrual_Syndrome__PMS__and_Premenstrual_Dysphoric_Disorder__PMDD_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) ID - 1688249 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688249/all/Premenstrual_Syndrome__PMS__and_Premenstrual_Dysphoric_Disorder__PMDD_ PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -