SM is a 24-year-old Asian Indian female who presents to her gynecologist with a chief complaint of “severe abdominal pain, breast tenderness, headaches, and weight gain” during her menstrual cycle. She states that her cramps feel like “pins through her stomach.” Her boyfriend states that SM cries sporadically during her menstruation and is often depressed. He also states that she appears to be a lot more anxious and tense during this time of the month. In addition, he has observed that her emotional and mental symptoms during her menstruation result in a strain in their relationship. SM experiences increased appetite and a marked lack of energy during this time. Although both SM and her boyfriend are aware of the premenstrual symptoms that most women experience during the menstrual cycle, they are convinced that her emotional disturbances during her menstruation need medical attention.
SM’s past medical history is insignificant, but her social history is of concern. She states that she drinks about three cans of Coke a day and doesn’t follow a “healthy” diet. Her usual diet consists of no breakfast, a small lunch consisting of “junk” food, and a vegetarian dinner. Furthermore, she denies following any exercise regimen. SM states that she takes about four to five 200-mg tablets of ibuprofen a day during her menstrual cycle with minimal relief.
The menstrual cycle: fluctuating levels of estrogen and progesterone contribute to symptoms of PMDD
Symptoms of menstruation have long been defined and studied, but clinicians have been struggling to define the more severe form of premenstrual syndrome (PMS) from which women suffer. This term has often been used to describe the emotional, behavioral, and physical symptoms women experience before menses, which subside following menstruation. Symptoms of PMS are experienced by more than 75% of women. More significantly, 3% to 8% of women suffer from the more severe form of PMS known as premenstrual dysphoric disorder (PMDD).
Over the last 20 years, PMDD has been studied extensively regarding its pathophysiology and treatment. Often, premenstrual dysphoric disorder is mistaken for PMS. Although PMDD is similar to PMS in that it causes much distress in women’s lives, it differs in its diagnostic criteria. Originally, in the early 1900s, the term late luteal phase dysphoric disorder (LLPDD) was used to describe the symptoms experienced by women during the late luteal phase of their menstrual cycle. As these symptoms were studied further, the term premenstrual syndrome was coined in the 1950s and used instead to describe the physical and psychological symptoms occurring a few weeks before menses.
It was not until about 1990 that a more severe form of premenstrual syndrome was established and termed premenstrual dysphoric disorder. In April 2000, the American College of Obstetricians and Gynecologists (ACOG) published criteria for the diagnosis and treatment for PMDD, contributing to the awareness of this disorder and the study of further management. Premenstrual dysphoric disorder is not understood as well as PMS, but the many similarities between them have provided clinicians with a better understanding of its possible treatment options and pathological existence.
Although PMDD affects a small percentage of women, studies have found it to be a debilitating disorder that results in disruptions in relationships, work, and/or social activities at levels similar to those encountered with major depression. For health care providers, it is essential to understand the numerous aspects of this disorder by focusing on definitions, diagnosis, and treatment options.