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

section of gynecological disorders, as a disorder of the
female genital organs. The significance of the ICD-10
diagnosis is that it focuses on the two main aspects of
PMS:
● the association with the menstrual cycle
● cyclicity and timing.
It requires that symptoms occur exclusively during
the premenstrual period and remit following menses.
It de-emphasizes the nature of specific symptoms or
phenomena. It only gives examples such as tension or
migraine or any other molimen – any menstrually related
symptoms. It does not specify any level of required
severity or impairment, no degree of change from the
non-symptomatic phase of the menstrual cycle, and no
differential diagnosis or exclusion criteria (Table 2.3).
The ICD-9 code for PMS is 625.4.
ACOG diagnostic criteria
Conceptually similar, but a step forward from the ICD-
10 criteria are the American College of Obstetricians
and Gynecologists (ACOG) diagnostic criteria for premenstrual
syndrome (PMS) 27 (Table 2.3).
The ACOG diagnostic criteria require the reporting
of at least any one of six affective or one of four somatic
symptoms that should exist during the 5 days before the
menses at each of three prior menstrual cycles and be
DIAGNOSIS OF PMS/PMDD 11
Table 2.2 The burden of PMDD/PMS in the USA and the EU according to most conservative-strict definition:
disability adjusted life years (DALY) a lost
● Severity weight of severe PMS 0.50 (Class 5)
● Age of onset of PMS 14–17 years b
● Prevalence in teenagers 5.3–7.8%
● Duration of disease 14–51 years 37 years
● Cycles affected 481–22 (2 pregnancies and postpartum) 459 cycles
● Average days of severe PMS per cycle 6.1 days c
● Total days/years of disorders 2800 days/7.671 years
● DALY (7.671 � 0.5) 3.835 per woman
relieved within 4 days of onset of menses. They should
not exist until the periovulatory phase of the menstrual
cycle, be present in the absence of any pharmacological
therapy, be associated with impairment or dysfunction
in social or economic performance, and be prospectively
confirmed during two menstrual cycles.
The significance of the ACOG criteria is that they
acknowledge the importance of dysfunction and impairment,
specify the symptomatic and the asymptomatic
periods, and require prospective confirmation of retrospective
reports. In my opinion, the emphasis on timing,
with vagueness of nature of symptoms and requirement
for at least one symptom without a threshold of minimal
number of symptoms, is a conceptual and practical
strength of the ACOG criteria.
APA DSM-IV criteria
USA EU
● Women ages 14–51 (USA); 15–49 (EU) 2000 census 75,580,000 91,445,000
● Women who would meet criteria for PMDD (��5%) ��3,779,000 ��4,572,250
Total DALYs, lost years of healthy life ��14,492,465 ��17,534,579
The number would be even higher if all women suffering from PMS with impairment are counted
Data from a Murray and Lopez, 19 b Wittchen et al, 15 and c Hylan et al. 20
The most elaborate diagnostic criteria of a subtype of
PMS are the APA DSM-IV criteria for premenstrual dysphoric
disorder – PMDD. 1,2 This set of criteria requires
an initial retrospective report that symptoms, their
luteal–follicular cyclicity, luteal occurrences, and follicular
absence have been presented for the majority of
cycles during the previous year. At least five out of 11
listed symptoms must be present; at least one of them
should be a major mood symptom – depression, anxiety,
irritability, or affective lability. Symptoms should cause
impairment and interfere with work, social activities,