Premenstrual dysphoric disorder is a severe form of premenstrual syndrome in which mood symptoms appear in the week before the period and fade within a few days after it starts. The symptoms are strong enough to disrupt work, school or relationships, which sets it apart from ordinary premenstrual changes.
Key symptoms
- Marked irritability, anger or conflict with others
- Depressed mood, hopelessness or crying spells
- Anxiety, tension or feeling on edge
- Fatigue, food cravings, sleep changes and poor concentration
- Physical symptoms: breast tenderness, bloating, joint or muscle pain
What you find on exam
- Timing: symptoms in the luteal phase and a symptom-free week after menses
- Mental status exam and screening for suicidal thoughts
- Rule out depression or anxiety that persists all month
- General exam to look for thyroid disease or other medical causes
Tests
- Daily symptom diary for at least 2 menstrual cycles to confirm the pattern
- Thyroid tests (TSH) if symptoms suggest thyroid disease
- Pregnancy test when relevant
- No blood test confirms the diagnosis
Treatment basics
- First line: an SSRI such as fluoxetine or sertraline, daily or only in the luteal phase
- A combined oral contraceptive with drospirenone as an option
- Cognitive behavioral therapy, regular exercise and good sleep
- Limit alcohol and caffeine; reassess after 2 to 3 cycles
Red flags
- Suicidal thoughts during the premenstrual phase
- Symptoms present all month, suggesting another mood disorder
- Severe function loss despite treatment
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.