Premenstrual Dysphoric Disorder PMDD: Overview and Diagnosis

Premenstrual dysphoric disorder (PMDD) is a mood disorder characterised by emotional, cognitive, and physical symptoms. PMDD causes significant distress or impairment in menstruating women during the luteal phase of the menstrual cycle. The symptoms occur in the luteal phase (between ovulation and menses), improve within a few days after the onset of menses, and are minimal or absent in the week after menses. [1] PMDD has a profound impact on a woman’s quality of life and dramatically increases the risk of suicidal ideation and even suicide attempts. Many women of reproductive age experience discomfort or mild mood changes prior to menstruation. However, 5–8% experience severe premenstrual syndrome causing significant distress or functional impairment.Within this population of reproductive age, some will meet the criteria for PMDD

Symptoms

Severe mood swings, depression, irritability, agitation, uneasiness, change in appetite, severe fatigue, anxiety, anger insomnia/hypersomnia, breast tenderness, decreased interest in usual social activities, reduced interest in sexual activity, difficulty in concentration

Studies have found that those with PMDD are more at risk of developing postpartum depression after pregnancy.PMDD was added to the list of depressive disorders in the Diagnostic and Statistical Manual of Mental Disorders in 2013.

The International Society for the Study of Premenstrual Disorders (ISPMD) defines two categories of premenstrual disorders: core PMD and variant PMD. Core PMD has six characteristics, all mainly focusing on the cyclical nature of PMDD and its typical onset pre-menses tracked over the course of more than two menstrual cycles. The four classified Variant PMDs involve more unexpected variables that cause the onset of premenstrual distress; such as, PMD with absent menstruation or premenstrual exacerbation, wherein the symptoms of another pre existing psychological disorder may be heightened as a result of PMDD onset.

Differential diagnosis
Furthermore, many medical disorders are worsened prior to ordering menses, but these typically do not present strictly during the luteal phase.

Mood disorders – there is potential for patients to have psychiatric disorders with superimposed PMDD or psychiatric disorders. In order to establish the timeline of symptoms required for a diagnosis of PMDD symptoms need to be tracked using scales like the Calendar of Premenstrual Experiences or the Daily Record of Severity of Problems.

Menopausal transition – affective symptoms associated with the menopausal transition most commonly start when the menstrual cycle starts to become irregular or anovulatory whereas PMDD symptoms occur during the luteal phase of ovulatory cycles.

Thyroid disorders—patients with both hyperthyroidism and hypothyroidism may present with affective symptoms. The patient's history is very important to determine whether the provider should suspect thyroid disorders. Patients should also have thyroid hormone levels checked to ensure no underlying thyroid disorder is present.