Premenstrual syndrome and premenstrual dysphoric disorder (review)

Premenstrual syndrome

Premenstrual syndrome is defined as recurrent psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation. It affects 20-30% of premenopausal women.

Premenstrual dysphoric disorder

Premenstrual dysphoric disorder includes affective or somatic symptoms that cause severe dysfunction in social or occupational activity. It affects 3-8% of premenopausal women.

Proposed etiologies (causative factors) include:

- increased sensitivity to normal cycling levels of estrogen and progesterone
- increased aldosterone and plasma renin activity
- neurotransmitter abnormalities, particularly serotonin

The Daily Record of Severity of Problems is one tool with which women may self-report premenstrual symptoms.

Symptom relief is the goal, and there is limited evidence for the use of:

- calcium
- vitamin D
- vitamin B6 supplementation

Serotonergic antidepressants (SSRIs) (citalopram, escitalopram, fluoxetine, sertraline, venlafaxine) are first-line pharmacologic therapy.


Premenstrual syndrome and premenstrual dysphoric disorder. Biggs WS, Demuth RH. Am Fam Physician. 2011 Oct 15;84(8):918-24.

Image source:, public domain.

1 comment:

  1. Instead of using antidepressants, which treats the symptoms of premenstrual syndrome (PMS), I suggest to treat the cause of premenstrual syndrome. The cause is a lack of progesterone in a cyclical fashion. In other words there is a weakening of the function of the ovaries resulting in a relative lack of progesterone in the second half of a woman's menstrual cycle. I have described this in my medical web site under this link:
    Recently Dr. Herthoghe and Dr. Rothenberg have mentioned this treatment again at the 19 th World Congress of the A4M Society in Las Vegas in mid December 2011. The key is to use bio-identical progesterone cream instead of synthetic preparations that would not fit the progesterone receptors. When the hormones are rebalanced, the PMS symtoms disappear including mood swings and depression.
    Ray Schilling, MD Kelowna, BC Canada