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

severe PMS. The most common symptoms occurring in
about 80% of women in each country were irritability/
anger, physical swelling/bloating, and fatigue. Robinson
and Swindle conducted a cross-sectional survey of 1022
respondents from a nationally representative random
sample of US women, evaluating premenstrual symptoms,
social and occupational interference, healthcare
beliefs, and treatment-seeking behavior. The results
reported 11% meeting criteria for PMDD based on the
DSM-IV criteria, and 63% of women having moderate–
severe PMS. 24
Prevalence studies in adolescent women with prospective
charting of symptoms have not yet been conducted.
Studies utilizing retrospective reporting of PMS have
reported elevated and a wider range of prevalence rates
of PMS compared with adult women. Two recent studies
that retrospectively assessed the PMDD criteria in adolescent
women reported prevalence rates of 31% 24a
and 13.4%. 24b
Prevalence studies using retrospective
PMS criteria
Reviews exist of older published studies of prevalence
rates of PMS. 25,26 Some of the studies that were conducted
in population cohorts will be mentioned, even
though the studies utilized retrospective assessment of
premenstrual symptoms. Two studies examined the
prevalence of perimenstrual symptoms in a community
cohort of women in Switzerland evaluated five times
over 14 years. 27,28 Out of 299 women, 8.1% met criteria
for severe, and 13.6% met criteria for moderate,
perimenstrual emotional and somatic symptoms. 27 A
study of 894 women in Virginia who were assessed
over the telephone with the MDQ yielded 8.3% having
PMS. 29 Severe premenstrual symptoms were endorsed
by 2–3% of 1083 women in Sweden by mail survey. 30
Severe PMS with work impairment was reported in
3.2% of 730 nursing students in Iowa utilizing the
PAF. 31 Between 2 and 7% of 2650 Canadian women in
a population cohort met criteria for severe PMS by the
MDQ. 32 In addition, 3–12% of 191 women in a Seattle
area population cohort reported strong/disabling premenstrual
symptoms by the MDQ. 33
Prevalence studies in non-US countries
Several studies have examined the prevalence of premenstrual
symptoms, PMS, and PMDD in non-US samples.
Studies utilizing prospective confirmation of premenstrual
symptoms over one or two menstrual cycles have
reported prevalence rates of severe PMS or PMDD in
18.2% of 384 college students in Pakistan, 34 6.4% of
PREVALENCE, IMPACT ON MORBIDITY, AND DISEASE BURDEN 39
52 volunteer women in India, 35 12% of 150 women in
a PMS clinic in Taiwan, 36 and 2.4% in 83 women in a
population cohort in India. 37 Studies with retrospective
reporting of premenstrual symptoms have also been
conducted in Australia, Brazil, China, Egypt, Finland,
France, Great Britain, Hong Kong, India, Japan,
Mexico, Morocco, Nigeria, Spain, Taiwan, and
Zimbabwe. Cross-cultural comparisons have suggested
a predominance of somatic symptoms relative to emotional
symptoms in several ethnic cultures. Caucasian
women endorsed more emotional premenstrual symptoms
compared with Afro-Caribbean and Asian subgroups
in Great Britain, 38 and Australian and Italian
women endorsed more emotional than somatic symptoms
compared with Turkish, Vietnamese, and Greek
subgroups in Australia. 39
IMPACT OF PMDD ON FUNCTIONING,
QUALITY OF LIFE, AND HEALTHCARE
UTILIZATION
The morbidity of PMDD results from the severity
of the symptoms, the chronic nature of the disorder,
and the resulting impairment in work, relationships,
and activities. 40 Halbreich et al estimated that women
with PMDD endure 3.8 years of disability over their
reproductive years based on the global burden of
disease model, similar in magnitude to other major
medical and psychiatric disorders. 25 The assessment of
functioning and quality of life is difficult since it incorporates
subjective views as well as measurable ratings of
mental and physical health, work functioning, interpersonal
functioning, and a sense of well-being. 41 In
general, studies of role functioning in women with PMS
and PMDD report greater subjective distress with the
effect of premenstrual symptoms on interpersonal relationships
compared to work performance.
In addition to the morbidity and functional impairment
from PMDD, healthcare utilization also contributes
to the disease burden. The assessment of healthcare utilization
due to PMDD is difficult. Many studies assessing
treatment utilization were conducted prior to the
Food and Drug Administration (FDA) approval of selective
serotonin reuptake inhibitors (SSRIs) for PMDD in
2000. Even though SSRIs are frequently used for PMDD
currently, the diagnosis code attached to the SSRI prescription
(as well as to the visit to the healthcare practitioner)
is rarely the code for PMDD; it is more often a
code for depression, anxiety disorder, or a medical condition.
Thus, it is likely that prescription rates for
medications for severe PMS and PMDD are largely
underreported. The following summary of studies