Women with premenstrual symptoms (PMS) and premenstrual dysphoric disorder experience symptoms during the premenstrual phase of their cycles. Because levels of estrogen and progesterone do not differ significantly between women with PMS and those without, it has long been hypothesized that PMS/PMDD represents an abnormal response to normal hormonal fluctuations (Schmidt et al, 1998).
The American Psychiatric Association is now considering the possibility of including premenstrual dysphoric disorder (PMDD) in the DSM-V as a new category, rather than listing a set of criteria for PMDD in the appendix (as in DSM-IV). The diagnostic criteria remain relatively unchanged. Many feel that the Inclusion of PMDD as a distinct diagnostic category will lead to greater legitimacy for the disorder and will encourage the growth of evidence-based research in this area.
Premenstrual worsening of mood is common among women with depression, but little is known about how often women with bipolar disorder experience worsening of their mood premenstrually. In a study by Payne et al. (2007), premenstrual symptoms were reported by twice as many women diagnosed with mood disorders (mixture of Bipolar Disorder and Major Depressive Disorder) than by women who did not have a psychiatric diagnosis (67.7% vs. 33.7%). These results suggest that PMS symptoms are particularly common in women with bipolar disorder and major depressive disorder. However, this study involved women reporting prior experiences with PMS, which is not always as accurate as studies that involve prospective monitoring to obtain real-time reporting of PMS symptoms. Such prospective studies of PMS in women with bipolar disorder are sparse and have inconsistent conclusions.
During the two weeks prior to the onset of a menstrual period, many women experience physical symptoms, such as bloating, breast tenderness, headache, and muscle aches. A small proportion of women also note a change in their mood and complain of irritability, mood swings, depressed mood, or feeling tense. If these symptoms interfere with a woman's ability to function, she may have premenstrual dysphoric disorder (PMDD).
Selective Serotonin Reuptake Inhibitors or SSRIs have been shown to be effective for the treatment of premenstrual symptoms. These medications are not only useful for treating the irritability, depression and anxiety that occur during the 1-2 weeks before the menstrual period but may also help alleviate some of the physical symptoms of PMS.
