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

• 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