Premenstrual Mood Changes
Many women in their reproductive years experience transient physical and emotional changes around the time of their period. In fact, at least 75% of women with regular menstrual cycles report unpleasant physical or psychological symptoms premenstrually. For the majority of women, these symptoms are mild and tolerable. However, for a certain group of women, these symptoms can be disabling and may cause significant disruption in their lives.
Premenstrual Syndrome (PMS)
First introduced in the 1950s, the term “PMS” has been widely used by the popular press and thus has been variably defined. PMS is a broader term that typically refers to a general pattern of physical, emotional, and behavioral symptoms occurring 1-2 weeks before menses and remitting with the onset of menses. PMS is common, affecting from 30-80% of women of reproductive age. The most common physical symptoms include abdominal bloating, headaches, muscle and joint pain, and breast tenderness. The behavioral symptoms most commonly observed in women with PMS are fatigue, forgetfulness, poor concentration, and mild mood changes, including irritability and depressed mood.
Premenstrual Dysphoric Disorder (PMDD)
Premenstrual dysphoric disorder (PMDD) is a more severe form of premenstrual syndrome affecting 3-8% of women in their reproductive years. In contrast to PMS, PMDD is characterized by more significant premenstrual mood disturbance. The most common symptom is irritability; however, many women also report depressed mood, anxiety, or mood swings. These symptoms emerge one to two weeks preceding menses and resolve completely with the onset of menses. By definition, this mood disturbance results in marked social or occupational impairment, with its most prominent effects in interpersonal functioning.
PMDD is a psychiatric diagnosis and is considered to be one of the affective disorders, classified in the DSM-IV-TR as “depressive disorder not otherwise specified.” Premenstrual exacerbation (PME) is a term used to refer to mood worsening during the premenstrual phase when the primary diagnosis is another mood disorder (such as major depression or bipolar disorder). Typically PMDD emerges in women in their 20′s and may worsen over time; it has been observed that some women may experience worsening premenstrual symptoms as they enter into the menopause. Less commonly, PMDD may begin during adolescence, and case reports suggest that treatments effective for adult women can also be helpful to adolescents with PMDD. Risk factors for PMDD include psychiatric history of a mood or anxiety disorder, family history of premenstrual mood dysregulation, stress, and age in the late 20′s to mid-30′s.
It is important for clinicians to distinguish between PMDD and other medical and psychiatric conditions. Medical illnesses such as chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, and migraine disorder can have features that overlap with PMDD. Additionally, psychiatric disorders such as depression or anxiety disorders can worsen during the premenstrual period and thus may mimic PMDD.
An estimated 40% of women who seek treatment for PMDD actually have a premenstrual exacerbation of an underlying mood disorder rather than PMDD. PMDD can be distinguished from other affective disorders primarily by the cyclical nature of the mood disturbance. Unlike other affective disorders, mood symptoms are only present for a specific period of time, during the luteal phase of the menstrual cycle. Additionally, these mood symptoms do not occur in the absence of a menstrual cycle, as during reproductive events such as pregnancy or menopause.
The best way to confirm the diagnosis of PMDD is by prospective daily charting of symptoms. Women with PMDD should experience a symptom-free interval between menses and ovulation. Although there is no consensus about the best instrument by which to confirm the diagnosis of PMDD, two well-validated scales for the recording of premenstrual symptoms include the Calendar of Premenstrual Experiences (COPE) and the Prospective Record of the Severity of Menstruation (Prism)
Source: womensmentalhealth.org.
At Fairfax Mental Health, our psychiatrists treat this and other conditions. Call us at 703-830-1500 to discuss your needs or schedule an appointment.
