Premenstrual Syndromes : PMS and PMDD - Rutuja :: The site ...

150 THE PREMENSTRUAL SYNDROMES
Table 17.1 ACOG diagnostic criteria for
premenstrual syndrome (PMS)
Affective symptoms Somatic symptoms
Depression Breast tenderness
Anger Abdominal bloating
Irritability Headache
Anxiety
Confusion
Social withdrawal
Swelling of extremities
PMS can be diagnosed after the patient prospectively
documents at least one of the affective or somatic
symptoms during the 5 days prior to menses for three
menstrual cycles. Symptoms should be of such severity
as to impact social or economic performance. Symptoms
should abate during the first 4 days of the menstrual
cycle and not recur until at least cycle day 13. There
should be no concomitant pharmacological therapy,
hormone ingestion, or drug or alcohol abuse.
Adapted from ACOG. 2
Table 17.2 DSM-IV criteria for premenstrual dysphoric disorder (PMDD)
1. Experience five or more symptoms, including at least one core symptom:
● Markedly depressed mood, hopelessness, self-deprecating thoughts a
● Marked anxiety, tension a
● Marked affective lability a
● Persistent and marked anger or irritability a
Diagnostic criteria for PMDD, found in the Diagnostic
and Statistical Manual of Mental Disorders, fourth
edition, text revision (DSM-IV-TR), are more specific
and include endorsement of five or more of the symptoms
listed in Table 17.2, with at least one being a core
symptom. 5
Further PMS criteria are that the symptoms must be
present during the last week of the luteal phase in most
of the woman’s menstrual cycles in the previous year,
be relieved within the first few days of the follicular
phase of the cycle, and must not have recurred during
the week that follows menses. The criteria must be
confirmed by prospective daily ratings for at least two
consecutive symptomatic cycles. The symptoms must
not represent an exacerbation of another disorder, such
as a depressive or anxiety disorder, substance abuse, a
personality disorder, perimenopause, or thyroid disease,
although they can be superimposed on such a disorder.
A diagnosis of PMDD requires that the symptoms be
severe enough to interfere with the woman’s work,
social interactions, or usual activities. The National
Institute of Mental Health also defines premenstrual
changes as showing at least a 30% increase in symptom
intensity during the late luteal phase of the cycle (6 days
● Decreased interest in usual activities
● Subjective sense of difficulty in concentrating
● Subjective sense of being out of control
● Lethargy, easy fatigability
● Marked change in appetite
● Hypersomnia or insomnia
● Other physical symptoms, such as breast tenderness-headache.
2. Report symptoms during the last week of the luteal phase, with remission within a few days of the onset of menses
3. Document absence of symptoms during the week following menses
4. Demonstrate marked interference of symptoms with work, school, or social activities and relationships
5. Symptoms are not an exacerbation of another disorder
6. Prospective daily ratings confirm three of the above criteria during at least two consecutive symptomatic menstrual
cycles.
a Core symptoms; PMDD can be diagnosed when, for most of the 12 cycles, the above criteria are met. Adapted from the
Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). Washington DC: American Psychiatric
Association; 1994: 715–18.