CE/CME / PEER REVIEWED

Premenstrual Dysphoric Disorder: Diagnosis and Management in Primary Care

Clinician Reviews. 2018 December;28(12):40-45

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.
2. Rapkin AJ, Lewis EI. Treatment of premenstrual dysphoric disorder. Womens Health (Lond). 2013;9(6):537-556.
3. Pearlstein T. Treatment of premenstrual dysphoric disorder: therapeutic challenges. Expert Rev Clin Pharmacol. 2016;9(4):493-496.
4. Zielinski R, Lynne S. Menstrual-cycle pain and premenstrual conditions. In: Schuiling KD, Likis FE, eds. Women’s Gynecologic Health. Burlington, MA: Jones & Bartlett Learning; 2017:556-573.
5. Hofmeister S, Bodden S. Premenstrual syndrome and premenstrual dysphoric disorder. Am Fam Physician. 2016;94(3):236-240.
6. Yonkers KA, Simoni MK. Premenstrual disorders. Am J Obstet Gynecol. 2018;218(1):68-74.
7. Yang M, Wallenstein G, Hagan M, et al. Burden of premenstrual dysphoric disorder on health-related quality of life. J Womens Health (Larchmt). 2008;17(1):113-121.
8. Craner JR, Sigmon ST, McGillicuddy ML. Does a disconnect occur between research and practice for premenstrual dysphoric disorder (PMDD) diagnostic procedures? Women Health. 2014;54(3):232-244.
9. Hong JP, Park S, Wang HR, et al. Prevalence, correlates, comorbidities, and suicidal tendencies of premenstrual dysphoric disorder in a nationwide sample of Korean women. Soc Psychiatry Psychiatr Epidemiol. 2012;47(12): 1937-1945.
10. Martinez PE, Rubinow PR, Nieman LK, et al. 5α-reductase inhibition prevents the luteal phase increase in plasma allopregnanolone levels and mitigates symptoms in women with premenstrual dysphoric disorder. Neuropsychopharmacology. 2016;41:1093-1102.
11. Baller EB, Wei SM, Kohn PD. Abnormalities of dorsolateral prefrontal function in women with premenstrual dysphoric disorder: A multimodal neuroimaging study. Am J Psychiatry. 2013;170(3):305-314.
12. Comasco E, Sundström-Poromaa I. Neuroimaging the menstrual cycle and premenstrual dysphoric disorder. Curr Psychiatry Rep. 2015;17:77.
13. Reid RL. Premenstrual dysphoric disorder (formerly premenstrual syndrome) [Updated Jan 23, 2017]. In: De Groot LJ, Chrousos G, Dungan K, et al, eds. Endotext [Internet]. South Dartmouth, MA: MDText.com, Inc; 2000.
14. Htay TT. Premenstrual dysphoric disorder clinical presentation. Medscape. https://emedicine.medscape.com/article/293257-clinical#b3. Updated February 16, 2016. Accessed February 7, 2018.
15. Epperson CN, Hantsoo LV. Making strides to simplify diagnosis of premenstrual dysphoric disorder. Am J Psychiatry. 2017;174(1):6-7.
16. FDA. Sarafem. www.accessdata.fda.gov/drugsatfda_docs/label/2006/021860lbl.pdf. Accessed February 15, 2018.
17. FDA. Paxil CR. www.accessdata.fda.gov/drugsatfda_docs/label/2004/20936se2-013_paxil_lbl.pdf. Accessed February 15, 2018.
18. FDA. Zoloft. www.accessdata.fda.gov/drugsatfda_docs/label/2016/019839s74s86s87_20990s35s44s45lbl.pdf. Accessed February 15, 2018.
19. Yonkers KA, Kornstein SG, Gueorguieva R, et al. Symptom-onset dosing of sertraline for the treatment of premenstrual dysphoric disorder: a randomized trial. JAMA Psychiatry. 2015;72(10):1037-1044.
20. Busse JW, Montori VM, Krasnik C, et al. Psychological intervention for premenstrual syndrome: a meta-analysis of randomized controlled trials. Psychother Psychosom. 2009;78(1):6-15.
21. Shobeiri F, Araste FE, Ebrahimi R, et al. Effect of calcium on premenstrual syndrome: a double-blind randomized clinical trial. Obstet Gynecol Sci. 2017;60(1):100-105.
22. Nevatte T, O’Brien PMS, Bäckström T, et al. ISPMD consensus on the management of premenstrual disorders. Arch Womens Ment Health. 2013;16(4):279-291.

Additionally, the symptoms must cause clinically significant distress or impair daily functioning, including occupational, social, academic, and sexual activities (Criterion D). They must not represent exacerbation of another underlying psychiatric disorder, such as major depressive, dysthymic, panic, or personality disorders (Criterion E), although PMDD may co-occur with psychiatric disorders.¹

The above-mentioned symptom profile must be confirmed by prospective daily ratings of a minimum of two consecutive symptomatic menstrual cycles (Criterion F), although a provisional diagnosis of PMDD may be made prior to confirmation.¹ The Daily Record of Severity of Problems is the most widely used instrument for prospective daily rating of PMDD symptoms listed in the DSM-5 criteria.^5,15

Finally, the symptoms must not be evoked by the use of a substance (eg, medications, alcohol, and illicit drugs) or another medical condition (Criterion G).¹

TREATMENT/MANAGEMENT

The goal of PMDD treatment is to relieve psychiatric and physical symptoms and improve the patient's ability to function.³ Treatment is primarily directed at pharmacologic neuromodulation using selective serotonin reuptake inhibitors (SSRIs) or ovulation suppression using oral contraceptives and hormones.²

Pharmacotherapy

SSRIs are the firstline treatment for PMDD.⁵ Fluoxetine, paroxetine, and sertraline are the only serotonergic medications approved by the FDA for treatment of PMDD.² SSRIs act within one to two days when used for PMDD, thereby allowing different modes of dosing.² SSRI dosing may be continuous (daily administration), intermittent (administration from ovulation to first day of menses), or symptomatic (administration from symptom onset until first day of menses).³ Although data on continuous and intermittent dosing are available for fluoxetine, paroxetine, and sertraline, symptom-onset data are currently available only for sertraline (see Table 2).^16-19

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References

PCOS linked to increased cancer risk in premenopausal women

Premenstrual Dysphoric Disorder: Diagnosis and Management in Primary Care

References

TREATMENT/MANAGEMENT

Pharmacotherapy

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