Affective Symptoms

Premenstrual disorders encompass a spectrum of cyclic affective and physical symptoms that interfere with daily functioning, occurring during the luteal phase and resolving with or immediately following menstruation. Premenstrual disorders may be caused by fluctuations of estrogen in the luteal phase, leading to dysregulation of serotonin, increased sensitivity to changes in the progesterone metabolite allopregnanolone, or both. Diagnosis can be made based on symptom assessment with daily ratings for at least 2 consecutive menstrual cycles, such as the Daily Record of Severity of Problems.1,2 Affective symptoms include lability (mood swings, sudden sadness or tearfulness, sensitivity to rejection), irritability or anger, depressed mood, and anxiety or tension. Physical symptoms include difficulty concentrating, lethargy or fatigue, appetite changes, sleep disturbances, breast tenderness, joint pain, and abdominal bloating.

Premenstrual syndrome (PMS) is characterized by the cyclic occurrence of any of these affective or physical findings during the premenstrual period and affects approximately one-quarter of menstruating individuals. Premenstrual dysphoric disorder (PMDD) is more severe than PMS and less common (affecting 2%-5% of females). Based on the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5), the diagnosis of PMDD requires at least 5 symptoms, including at least 1 affective symptom and 1 physical symptom, the week before menses. Symptoms of PMDD substantially decrease or resolve the week after menses.1,2 Treatment choices are based on the timing and severity of symptoms and patient goals such as desire for contraception.