Highlights
- •Etiological theories of premenstrual dysphoric disorder (PMDD) suggest a sensitivity to hormonal and serotonergic changes during the luteal phase of menstrual cycle.
- •PMDD may be managed by nurse practitioners within primary care and gynecology settings, along with support from psychiatric mental health nurse practitioners.
- •Prospective rating scales are recommended to confirm PMDD diagnosis.
- •Pharmacologic treatment options include antidepressants and combined oral contraceptives. Nonpharmacologic interventions for symptom management, such as psychotherapy, dietary changes, and physical activity are also reviewed.
Abstract
Premenstrual dysphoric disorder is a depressive disorder associated with the luteal
phase of the menstrual cycle. It affects 1.5%–5.8% of individuals who menstruate and
is characterized by the presence of emotional, cognitive, behavioral, and somatic
symptoms. Symptoms should be assessed over 2 menstrual cycles with the use of prospective
rating scales for adequate diagnosing. Treatment includes pharmacologic approaches,
such as antidepressants or hormone therapy, as well as nonpharmacologic lifestyle
modifications and psychotherapy. This clinical feature is intended to inform nursing
practice and present future considerations for a wide array of patient populations
who experience this condition.
Keywords
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References
- Emotion regulation in women with premenstrual dysphoric disorder.Arch Womens Ment Health. 2016; 19: 891-898https://doi.org/10.1007/s00737-016-0634-4
- Diagnostic and Statistical Manual of Mental Disorders.in: 5th ed.,text revision. American Psychiatric Association, 2022
- Recent advances in understanding/management of premenstrual dysphoric disorder/premenstrual syndrome.Fac Rev. 2022; 11: 11https://doi.org/10.12703/r/11-11
- The etiology of premenstrual dysphoric disorder: 5 interwoven pieces.Curr Psychiatr. 2017; 16: 21
- How to study the menstrual cycle: Practical tools and recommendations.Psychoneuroendocrinology. 2021; 123104895https://doi.org/10.1016/j.psyneuen.2020.104895
- Premenstrual syndrome, a common but underrated entity: review of the clinical literature.J Turk Ger Gynecol Assoc. 2021; 22: 139-148https://doi.org/10.4274/jtgga.galenos.2021.2020.0133
- Suicidality in women with premenstrual dysphoric disorder: a systemic literature review.Arch Womens Ment Health. 2021; 24: 173-184https://doi.org/10.1007/s00737-020-01054-8
- Premenstrual syndrome: evidenced-based evaluation and treatment.Clin Obstet Gynecol. 2018; 61: 52-61https://doi.org/10.1097/GRF.0000000000000339
- Ulipristal acetate for treatment of premenstrual dysphoric disorder: a proof-of-concept randomized controlled trial.Am J Psychiatry. 2021; 178: 256-265https://doi.org/10.1176/appi.ajp.2020.20030286
- Suicidality in patients with premenstrual dysphoric disorder—A systematic review and meta-analysis.J Affect Disord. 2021; 295: 339-346https://doi.org/10.1016/j.jad.2021.08.082
- Normal menstrual cycle.in: Crowley W.F. Blake D. UpToDate. 2022https://www-uptodate-com.treadwell.idm.oclc.org/contents/normal-menstrual-cycleDate accessed: June 30, 2022
- Neuroimaging the menstrual cycle and premenstrual dysphoric disorder.Curr Psychiatry Rep. 2015; 17: 77https://doi.org/10.1007/s11920-015-0619-4
- Progesterone—friend or foe?.Front Neuroendocrinol. 2020; 59100856https://doi.org/10.1016/j.yfrne.2020.100856
- Women’s experiences of receiving a diagnosis of premenstrual dysphoric disorder: a qualitative investigation.BMC Womens Health. 2020; 20: 242https://doi.org/10.1186/s12905-020-01100-8
- Psychiatric symptoms and disorders associated with reproductive cyclicity in women: advances in screening tools.Womens Health. 2015; 11: 399-415https://doi.org/10.2217/whe.15.1
- Premenstrual syndrome diagnosis: a comparative study between the Daily Record of Severity of Problems (DRSP) and the Premenstrual Symptoms Screening Tool (PSST).Rev Bras Ginecol Obstet. 2018; 40: 20-22https://doi.org/10.1055/s-0037-1608672
- Allopregnanolone in premenstrual dysphoric disorder (PMDD): Evidence for dysregulated sensitivity to GABA-A receptor modulating neuroactive steroids across the menstrual cycle.Neurobiol Stress. 2020; 12100213https://doi.org/10.1016/j.ynstr.2020.100213
- Premenstrual dysphoric disorder.Med Clin North Am. 2019; 103: 613-628https://doi.org/10.1016/j.mcna.2019.02.007
- Premenstrual dysphoric disorder: epidemiology and treatment.Curr Psychiatry Rep. 2015; 17: 87https://doi.org/10.1007/s11920-015-0628-3
- Treatment of premenstrual dysphoria with continuous versus intermittent dosing of oral contraceptives: Results of a three-arm randomized controlled trial.Depress Anxiety. 2017; 34: 908-917https://doi.org/10.1002/da.22673
- Pilot data on the feasibility and clinical outcomes of a nomegestrol acetate oral contraceptive pill in women with premenstrual dysphoric disorder.Front Endocrinol. 2021; 12704488https://doi.org/10.3389/fendo.2021.704488
- Premenstrual dysphoric disorder symptoms following ovarian suppression: triggered by change in ovarian steroid levels but not continuous stable levels.Am J Psychiatry. 2017; 174: 980-989https://doi.org/10.1176/appi.ajp.2017.16101113
- Toward more targeted and cost-effective gonadotropin-releasing hormone analog treatment in girls with central precocious puberty.Horm Res Paediatr. 2018; 90: 1-7https://doi.org/10.1159/000491103
- Double-blind, placebo-controlled pilot study of adjunctive quetiapine SR in the treatment of PMS/PMDD.Hum Psychopharmacol. 2015; 30: 425-434https://doi.org/10.1007/s11920-015-0628-3
- Internet-based cognitive-behavioral intervention for women with premenstrual dysphoric disorder: a randomized controlled trial.Psychother Psychosom. 2019; 88: 16-29https://doi.org/10.1159/000496237
- Effect of exercise on premenstrual symptoms: a systematic review.Complement Ther Med. 2020; 48102272https://doi.org/10.1016/j.ctim.2019.102272
- Exercise for premenstrual syndrome: A systematic review and meta-analysis of randomised controlled trials.BJGP Open. 2020; 4bjpopen20X101032https://doi.org/10.3399/bjgpopen20X101032
- Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review.Arch Womens Ment Health. 2017; 20: 713-719https://doi.org/10.1007/s00737-017-0791-0
- Effects of zinc supplementation on physical and psychological symptoms, biomarkers of inflammation, oxidative stress, and brain-derived neurotrophic factor in young women with premenstrual syndrome: a randomized, double-blind, placebo-controlled trial.Biol Trace Elem Res. 2020; 194: 89-95https://doi.org/10.1007/s12011-019-01757-9
- Beneficial role of calcium in premenstrual syndrome: a systematic review of current literature.Int J Prev Med. 2020; 11: 156https://doi.org/10.4103/ijpvm.IJPVM_243_19
- The effects of magnesium supplementation on subjective anxiety and stress—a systematic review.Nutrients. 2017; 9: 429https://doi.org/10.3390/nu9050429
- Serum antioxidant vitamin concentrations and oxidative stress markers associated with symptoms and severity of premenstrual syndrome: a prospective cohort study.BMC Womens Health. 2021; 21: 49https://doi.org/10.1186/s12905-021-01187-7
Biography
Amy P. Biondo, MSN, PMHNP-BC, LMHC, is a licensed mental health counselor, New York, NY, and can be contacted at [email protected]
Biography
Margaret J. Brown, DNP, PMHNP-BC, is an assistant professor, MGH Institute of Health Professions, Boston, MA.
Article info
Publication history
Published online: September 02, 2022
Publication stage
In Press Corrected ProofFootnotes
In compliance with standard ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.
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