Premenstrual Syndrome and PMDD

PMS/PMDD: Core Concepts - Cycle's Moody Blues

• Premenstrual Syndrome (PMS): Recurrent, cyclical physical, emotional, and behavioral symptoms.
  • Symptoms emerge during the late luteal phase.
  • Resolve within a few days of menstruation onset.
• Premenstrual Dysphoric Disorder (PMDD): A severe, functionally impairing variant of PMS.
  • Characterized by prominent mood symptoms: irritability, depression, anxiety.

⭐ PMDD is a severe form of PMS, formally recognized as a Depressive Disorder in DSM-5, requiring specific criteria for diagnosis.

PMS/PMDD: Etiopathogenesis - Hormone Havoc HQ

• Central Mechanism: Abnormal brain response to normal cyclical ovarian hormone changes. Not a hormone deficiency/excess.
• Hormonal Triggers:
  • Estrogen & Progesterone: Luteal phase fluctuations.
  • Allopregnanolone (progesterone metabolite): Key modulator of GABA-A receptors; altered sensitivity/response implicated.
• Neurotransmitter Dysregulation:
  • Serotonin (5-HT): ↓ activity, especially in luteal phase. (📌 PMS: Serotonin Suffers)
  • GABA System: Dysfunctional interaction with allopregnanolone.
  • β-endorphins: Possible withdrawal.
• Predisposing Factors:
  • Genetic vulnerability.
  • Stress.

⭐ The leading theory for PMS/PMDD involves an abnormal central nervous system response (especially serotonergic) to normal cyclical fluctuations of ovarian steroids, particularly allopregnanolone's effect on GABA-A receptors.

PMS/PMDD: Diagnosis Decoded - Symptom Sleuthing

• Key: Symptoms cyclical: luteal phase onset, resolve post-menses.
• Symptom Clusters:
  • Affective: Mood swings, irritability, depression, anxiety.
  • Somatic: Breast tenderness, bloating, headache, fatigue.
• Diagnostic Approach:
  • Symptom Diary: Essential for ≥2 cycles (confirms pattern, impact).
  • Rule out: Thyroid disorders, anemia, psychiatric conditions.
• ACOG Criteria (PMS):
  • ≥1 affective AND ≥1 somatic symptom.
  • Occur 5 days pre-menses (for ≥3 prior cycles).
  • Resolve within 4 days post-menses onset.
  • Functional impairment.
• DSM-5 Criteria (PMDD):
  • ≥5 symptoms (incl. ≥1 core affective) week before menses, improve with menses.
  • Core Affective: Marked lability, irritability, depressed mood, anxiety.
  • Other: ↓interest, ↓concentration, lethargy, appetite/sleep changes, overwhelmed, physical sx.
  • Significant distress/impairment. Confirmed by prospective daily ratings (≥2 cycles).

⭐ Diagnosis of PMS/PMDD critically relies on prospective daily symptom recording for at least two consecutive menstrual cycles to confirm the luteal phase timing and impact on functioning.

PMS/PMDD: Treatment Pathways - Taming the Tide

• Treatment approach is stepwise, based on symptom severity.

⭐ SSRIs (e.g., Fluoxetine, Sertraline, Paroxetine) are the first-line pharmacological treatment for moderate-to-severe PMDD, effective with continuous or luteal-phase-only dosing.

High‑Yield Points - ⚡ Biggest Takeaways

• PMS/PMDD: Cyclic symptoms (mood, physical) in luteal phase, resolving with menses.
• PMDD: Severe form of PMS with marked functional impairment or distress.
• Diagnosis: Requires prospective daily symptom ratings over ≥2 menstrual cycles.
• SSRIs (e.g., fluoxetine, sertraline) are first-line pharmacotherapy, especially for PMDD.
• Lifestyle changes (diet, exercise) and calcium supplementation can alleviate mild symptoms.
• Combined OCPs (especially drospirenone-containing) can be effective by suppressing ovulation.