Premenstrual Dysphoric Disorder: Burden of Illness and Treatment Update

Abstract

291Five percent of menstruating women have severe premenstrual symptoms and impairment of functioning defined as premenstrual dysphoric disorder (PMDD). Clinically significant premenstrual symptoms occur in at least an additional 20% of menstruating women. The diagnosis of PMDD should be confirmed by prospective symptom charting over 2 menstrual cycles to confirm the timing of the symptoms and to rule out other diagnoses. The burden of illness of PMDD includes disruption of parenting and partner relationships and decreased productivity in work roles. In addition, women with PMDD have increased use of health care services such as clinician visits and increased use of prescription medications and over-the-counter preparations. The etiology of PMDD is multifactorial. In particular, dysregulation of the serotonin and allopregnanolone systems is implicated. Several effective treatment options exist, including serotonergic antidepressant medications and an oral contraceptive that contains ethinyl estradiol and drosperinone. In addition, other hormones that suppress ovulation, anxiolytics, cognitive therapy, chasteberry and calcium may be helpful.Cinq pour cent des femmes menstruées ont des symptômes prémenstruels sévères et une incapacité du fonctionnement appelée trouble dysphorique prémenstruel (TDPM). Au moins 20 % de femmes menstruées de plus ont des symptômes prémenstruels cliniquement significatifs. Il faut confirmer le diagnostic de TDPM en suivant les symptômes de façon prospective au cours de deux cycles menstruels afin de confirmer le moment de l'apparition des symptômes et d'exclure d'autres diagnostics. Le fardeau morbide imposé par le TDPM comprend la perturbation des relations avec les enfants et le partenaire et une baisse de productivité au travail. Les femmes atteintes de TDPM ont en outre recours davantage aux services de santé comme les visites aux cliniciens et prennent davantage de médicaments d'ordonnance et en vente libre. L'étiologie du TDPM est multifactorielle. La dysrégulation des systèmes de la sérotonine et de l'allopregnanolone en particulier est mise en cause. Il existe plus d'un traitement efficace possible, y compris des antidépresseurs sérotonin-ergiques et un contraceptif oral qui contient de l'éthinyloestradiol et de la drosperinone. D'autres hormones qui bloquent l'ovulation, des anxiolytiques, la thérapie cognitive, le gattilier (Vitex agnus castus) et le calcium peuvent en outre aider. Review Paper Examen critique DiagnosisAbout 80% of women report at least mild premenstrual symptoms, 20%-50% report moderate-to-severe premenstrual symptoms, and about 5% report severe symptoms for several days with impairment of functioning.

Sleep quality in university students with premenstrual dysphoric disorder

“…In a retrospective design of PMDD assessment which is based on memory, the description of the women's mood symptoms are subjective and the recall of symptoms' severity and frequency may be amplified among these women. [27][28][29] Moreover, the responses may be associated with personality characteristics. Bailey and colleagues found that 40% of women diagnosed with PMS or PMDD also had comorbid affective or anxiety disorders.…”

Premenstrual dysphoric disorder and premenstrual syndrome: an overview

“…Contraceptive pill types containing ethinyl oestradiol and drospirenone may represent another effective treatment for PMDD (2). Not all evidence supports the use of contraceptives, but they could be considered as first-line pharmaceutical interventions for women with PMDD who also require contraception (23).…”

“…PMDD is characterised by affective, cognitive, behavioural, and somatic symptoms. PMDD and PMS have a negative impact on work attendance, productivity and relationships (2). Table 1 lists the symptoms associated with these two disorders.…”

The Clinical Relevance of Self-Reported Premenstrual Worsening of Depressive Symptoms in the Management of Depressed Outpatients: A STAR*D Report

“…33 Research on PME and PMDD has found high comorbidity with anxiety disorders and worsening of anxiety symptoms. 34,35 It is possible that the presence of severe premenstrual symptoms, whether PME or PMDD, may signal an increased risk for additional vulnerabilities/comorbid symptoms that increase the complication of illness and treatment. 15 Although the relationship and underlying mechanisms of PME and PMDD are not yet fully understood, 15 they may have important similarities or differences that, once we understand them, could assist in delivering more effective treatment.…”