Clinical epidemiology of premenstrual disorder: informing optimized patient outcomes

Figures & data

Table 1 The classification of premenstrual disorders

Premenstrual disorder category	Characteristics
Core premenstrual disorder	Symptoms occur in ovulatory cycles
	Symptoms are not specified – may be somatic and/or psychological
	Symptoms absent after menstruation and before ovulation
	Symptoms recur in luteal phase
	Symptoms must be prospectively rated (minimum of two cycles)
	Symptoms must cause significant disruption to lifestyle
Variants of PMD
Premenstrual exacerbation	Symptoms of an underlying psychological, somatic, or medical disorder significantly worsen premenstrually
PMD due to nonovulatory ovarian activity (rare)	Symptoms result from ovarian activity other than those of ovulation
Progestogen-induced PMD	Symptoms result from exogenous progestogen administration
PMD with absent menstruation	Symptoms from continued ovarian activity although no menstruation due to suppression or surgery

Note: Adapted from Springer in Archives of Women’s Mental Health. Volume 14(1). 2011. Pages 13–21. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. O’Brien PM, Bäckström T, Brown C, et al; with kind permission from Springer Science and Business Media.¹⁰

Abbreviation: PMD, premenstrual disorder.

Table 2 Summary of DSM-IV criteria for PMDD

A. Symptoms must occur during the week before menses and remit a few days after onset of menses	1. Depressed mood or dysphoria
	2. Anxiety or tension
Five of the following symptoms and at least one must be (1), (2), (3), or (4)	3. Affective lability
	4. Irritability
	5. Decreased interest in usual activities
	6. Concentration difficulties
	7. Marked lack of energy
	8. Marked change in appetite, overeating, or food cravings
	9. Hypersomnia or insomnia
	10. Feeling overwhelmed
	11. Other physical symptoms, ie, breast tenderness, bloating
B. Symptoms must interfere with work, school, usual activities, or relationships
C. Symptoms must not merely be an exacerbation of another disorder
D. Criteria A, B, and C must be confirmed by prospective daily ratings for at least two consecutive symptomatic menstrual cycles

Abbreviations: DSM-IV, American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, fourth Edition; PMDD, premenstrual dysphoric disorder.

Table 3 The premenstrual symptoms screening tool

Symptom	Not at all	Mild	Moderate	Severe
1. Anger/irritability
2. Anxiety/tension
3. Tearful/increased sensitivity to rejection
4. Depressed mood/hopelessness
5. Decreased interest in work activities
6. Decreased interest in home activities
7. Decreased interest in social activities
8. Difficulty concentrating
9. Fatigue/lack of energy
10. Overeating/food cravings
11. Insomnia
12. Hypersomnia (needing more sleep)
13. Feeling overwhelmed or out of control
14. Physical symptoms: breast tenderness, headaches, joint/muscle pain, bloating, weight gain
Have your symptoms, as listed above, interfered with:
A. Your work efficiency or productivity
B. Your relationships with coworkers
C. Your relationships with your family
D. Your social life activities
E. Your home responsibilities
Scoring
The following criteria must be present for a diagnosis of PMDD:
1) At least one of 1, 2, 3, or 4 is severe
2) In addition, at least 4 of 1–14 are moderate to severe
3) At least one of A, B, C, D, E is severe
The following must be present for a diagnosis of moderate to severe PMDD:
1) At least one of 1, 2, 3, or 4 is moderate to severe
2) In addition, at least 4 of 1–14 are moderate to severe
3) At least one of A, B, C, D, E is moderate to severe

Note: Adapted from Springer in Archives of Women’s Mental Health. Volume 6(3). 2003. Pages 203–209. The premenstrual symptoms screening tool (PSST) for clinicians. Steiner M, Macdougall M, Brown E; with kind permission from Springer Science and Business Media.³¹

Abbreviation: PMDD, premenstrual dysphoric disorder.

O’BrienPMBäckströmTBrownCTowards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensusArch Womens Ment Health2011141132121225438

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SteinerMMacdougallMBrownEThe premenstrual symptoms screening tool (PSST) for cliniciansArch Womens Ment Health20036320320912920618

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