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Premenstrual dysphoric disorder

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Title: Premenstrual dysphoric disorder  
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Subject: Menstruation, Wiki Ed/University of California, San Francisco/Expanding WikiProject Medicine (Fall Block 3), Premenstrual syndrome, Paroxetine, Menopause
Collection: Gynaecologic Disorders
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Premenstrual dysphoric disorder

Premenstrual dysphoric disorder
Classification and external resources
Specialty Psychiatry
ICD-10 F38.8
ICD-9-CM 311,[1] 625.4[2]
MedlinePlus 007193
eMedicine article/293257

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome affecting 3–8% of women.[3] It is a diagnosis associated primarily with the luteal phase of the menstrual cycle, comprising a "cluster of affective, behavioral and somatic symptoms".[3]


  • Symptoms 1
  • Causes 2
  • Diagnosis 3
  • Treatment 4
  • Epidemiology 5
  • References 6
  • External links 7


Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS). Like PMS, premenstrual dysphoric disorder follows a predictable, cyclic pattern. Symptoms begin in the late luteal phase of the menstrual cycle (after ovulation) and end shortly after menstruation begins.[4] On average, the symptoms last six days. The most intense symptoms occur two days before the start of menstrual blood flow through the first day of menstrual blood flow.[5]

Emotional symptoms are generally present, and in PMDD, mood symptoms are dominant.[4] Substantial disruption to personal relationships is typical for women with PMDD.[4] Anxiety, anger, and depression may also occur. The main symptoms, which can be disabling, include:

  • Feelings of sadness or despair, or even thoughts of suicide
  • Feelings of tension or anxiety
  • Panic attacks
  • Mood swings or frequent crying
  • Lasting irritability or anger that affects other people
  • Lack of interest in daily activities and relationships
  • Trouble thinking or focusing
  • Tiredness or low energy
  • Food cravings or binge eating
  • Trouble sleeping
  • Feeling out of control
  • Physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain

The symptoms occur during the week before menstruation, and go away once it starts. A diagnosis of PMDD requires the presence of at least five of these symptoms.


A demonstrable hormonal imbalance in women with PMDD has not been identified. It is hypothesized that normal ovarian function produces biochemical events in the nervous system that cause the premenstrual symptoms. These symptoms are more predominant in women who have a predisposition to the disorder.[4]


PMDD is listed in the DSM-IV, and was originally included as late luteal phase dysphoric disorder LLPDD in the DSM-III.[6] In many parts of the world, PMDD is not recognized as a disease. PMDD is not listed as a separate disorder in the World Health Organization's International Classification of Diseases (ICD).[7]

In 2003, the Committee for Proprietary Medicinal Products required the manufacturer of Prozac (fluoxetine) to remove PMDD from the list of indications for fluoxetine sold in Europe.[8] Reflecting the approach of the ICD-10, the committee found that

...PMDD is not a well-established disease entity across Europe... There was considerable concern that women with less severe pre-menstrual symptoms might erroneously receive a diagnosis of PMDD resulting in widespread inappropriate short and long-term use of fluoxetine.[9]

In Australia, PMDD is recognized by the Therapeutic Goods Administration. However, SSRIs are not reimbursed for PMDD under the Pharmaceutical Benefits Scheme.[10]


Selective serotonin reuptake inhibitors (SSRIs) are the first-line medication.[4] Unlike treatments for depressive disorders, SSRIs do not need to be taken daily but instead can be taken only in the luteal phase or during PMDD symptoms.[3] The U.S. Food and Drug Administration (FDA) has approved four SSRIs for the treatment of PMDD: Fluoxetine (available as generic or as Prozac or Sarafem), sertraline (Zoloft), paroxetine (Paxil), and escitalopram oxalate (Lexapro).

Hormonal birth control containing drospirenone and low levels of estrogen helps relieve severe PMDD symptoms, for at least the first three months it is used.[11]

There is some evidence that vitamin B6 can alleviate symptoms, but studies are of poor quality.[12]


Three to eight percent of women of reproductive age meet the PMDD criteria.[3]

Bipolar depression, anxiety disorders, and other Axis I disorders are more common in women with premenstrual dysphoric disorder (PMDD) than in women without PMDD.[13]


  1. ^ Halbreich U (December 2004). "The diagnosis of premenstrual syndromes and premenstrual dysphoric disorder--clinical procedures and research perspectives". Gynecol. Endocrinol. 19 (6): 320–34.  
  2. ^ Endicott J, McLaughlin TP, Grudzinski AN (December 2003). "Comparison of managed care charges among patients treated with selective serotonin reuptake inhibitors for premenstrual dysphoric disorder". J Clin Psychiatry 64 (12): 1511–6.  
  3. ^ a b c d Rapkin, AJ; Lewis, EI (November 2013). "Treatment of premenstrual dysphoric disorder". Womens Health (Lond Engl) 9 (6): 537–56.  
  4. ^ a b c d e Steiner, M; Pearlstein, T; Cohen, LS (2006). "Expert guidelines for the treatment of severe PMS, PMDD, and comorbidities: the role of SSRIs". J Womens Health (Larchmt) 15 (1): 57–69.  
  5. ^ Biggs WS, Demuth RH (October 2011). "Premenstrual syndrome and premenstrual dysphoric disorder". Am Fam Physician 84 (8): 918–24.  
  6. ^ Chrisler JC, Caplan P (2002). "The strange case of Dr. Jekyll and Ms. Hyde: how PMS became a cultural phenomenon and a psychiatric disorder". Annu Rev Sex Res 13: 274–306.  
  7. ^ Worcester, Nancy; Whatley, eds, Mariamne H. (2004). Women's health: Readings on social, economic, and political issues. Sage Publications. 
  8. ^ Ray Moynihan (2004-02-14). "Controversial disease dropped from Prozac product information". BMJ 328 (7436): 7436.  
  9. ^ European Agency for the Evaluation of Medicinal Products, Committee for Proprietary Medicinal Products (2003-06-13). "Summary Information...for Prozac and associated names" (PDF). 
  10. ^ Sertraline (Zoloft), fluoxetine (Lovan, Prozac) for premenstrual dysphoric disorder (PMDD) National Prescribing Service Limited. (Australia)
  11. ^ Lopez, LM.; Kaptein, AA.; Helmerhorst, FM. (2012). "Oral contraceptives containing drospirenone for premenstrual syndrome.". Cochrane Database Syst Rev 2: CD006586.  
  12. ^ Wyatt, Katrina; Paul Dimmock; Peter Jones; P M Shaughn O'Brien (22 May 1999). "Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review". BMJ 318 (7195): 1375–1381.  
  13. ^ Kim DR, Gyulai L, Freeman EW, Morrison MF, Baldassano C, Dubé B (February 2004). "Premenstrual dysphoric disorder and psychiatric co-morbidity". Arch Womens Ment Health 7 (1): 37–47.  

External links

  • Premenstrual dysphoric disorder at DMOZ
  • Diagnosis and Treatment of Premenstrual Dysphoric Disorder Am Fam Physician. 2002
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