ambossIconambossIcon

Premenstrual disorders

Last updated: February 4, 2025

Summarytoggle arrow icon

Premenstrual disorders are common cyclical conditions affecting menstruating individuals of reproductive age. They comprise premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Both PMS and PMDD are marked by affective and somatic symptoms that start in the luteal phase and resolve following menstruation. Both conditions affect an individual's daily life, with symptoms of PMDD causing significant impairment that is comparable in intensity to other mood disorders (e.g., major depressive disorder, generalized anxiety disorder). Diagnosis is made clinically with history, prospective symptom documentation over ≥ 2 consecutive menstrual cycles, and for PMDD, DSM-5 criteria for PMDD. Management is tailored to the patient's symptoms and includes lifestyle changes (e.g., regular exercise, dietary modifications), behavioral therapy, and/or pharmacotherapy (e.g., SSRIs, oral contraceptives).

Icon of a lock

Register or log in , in order to read the full article.

Overviewtoggle arrow icon

Comparison of PMS and PMDD [1][2]
Premenstrual syndrome (PMS) Premenstrual dysphoric disorder (PMDD)
Definition
  • The premenstrual onset of somatic and/or affective symptoms that cause disturbances in daily life
Symptoms
Impact
  • Impacts daily functioning
  • Significant interference in daily life (e.g., with work, home, and/or interpersonal relationships)
Diagnostic criteria

PMDD is classified as a depressive disorder and causes significant interference in daily life; ≥ 5 symptoms must be present for diagnosis. [1][3]

Icon of a lock

Register or log in , in order to read the full article.

Epidemiologytoggle arrow icon

  • Occurs in up to 12% of female individuals [2]
  • Age of onset: 20–30 years of age [2]

Epidemiological data refers to the US, unless otherwise specified.

Icon of a lock

Register or log in , in order to read the full article.

Clinical featurestoggle arrow icon

The following symptoms begin during the luteal phase, resolve following the onset of menses, and impact daily life. [1][2][3]

  • Premenstrual affective symptoms
    • Mood swings or emotional lability
    • Irritability, anger, or increased conflicts
    • Depressed mood
    • Anxiety, tension, and/or feeling on edge
  • Premenstrual somatic symptoms
    • Physical symptoms: joint pain, muscle pain, breast tenderness, fluid retention (e.g., bloating, weight gain, swelling of the extremities) [2]
    • Changes in appetite: overeating or cravings
    • Decreased interest in usual activities
    • Difficulty concentrating
    • Lethargy or lack of energy
    • Disordered sleep: hypersomnia or insomnia
    • Feeling overwhelmed or out of control
  • Other associated symptoms [1][4]
Icon of a lock

Register or log in , in order to read the full article.

Diagnosistoggle arrow icon

Approach [1][2]

Prospective documentation (e.g., with a patient diary) verifies symptoms, timing, and severity. [1]

The lack of a symptom-free period between menses and the next ovulation cycle indicates an alternative diagnosis. [1]

DSM-5 criteria for PMDD [3]

Symptoms must meet all of the following criteria:

PMDD may co-occur with other conditions (e.g., major depressive disorder). [3]

Icon of a lock

Register or log in , in order to read the full article.

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Icon of a lock

Register or log in , in order to read the full article.

Managementtoggle arrow icon

Approach [1][5]

There is no standard treatment; use a multimodal approach tailored to the patient's symptoms.

Lifestyle and dietary changes [1][2]

The following recommendations are based on low-quality evidence; used shared-decision making.

Pharmacotherapy [1][2]

Monotherapy or combination therapy may be used based on individual symptom severity.

In contrast to individuals with other depressive disorders, individuals with PMDD show a clinical response to SSRIs within days rather than weeks. [1]

Icon of a lock

Register or log in , in order to read the full article.

Start your trial, and get 5 days of unlimited access to over 1,100 medical articles and 5,000 USMLE and NBME exam-style questions.
disclaimer Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer