History

Elicit a description of cyclic symptoms that occur before the menstrual period and resolve with menses from patients with suspected premenstrual syndrome (PMS).

To establish the diagnosis, instruct patients to chart symptoms daily for two cycles. This usually demonstrates symptoms clustering around the luteal phase of ovulation, with resolution when menses begin.

Advise the patient to use a numeric scoring system to specify severity (1 for mild, 2 for moderate, 3 for severe) when recording symptoms. Ask the patient to bring her lists to the next appointment. The categories of PMS symptoms may be divided into five basic categories—A, C, D, H, and O—as follows.^{[17, 18, 12, 19]}

PMS-A (anxiety) symptoms include the following:

Difficulty sleeping
Tense feelings
Irritability
Clumsiness
Mood swings

PMS-C (craving) symptoms include the following:

Headache
Cravings for sweet foods
Cravings for salty foods
Cravings for other types of food

PMS-D (depression) symptoms include the following^[20]:

Depression
Angry feelings for no reason
Feelings that are easily upset
Poor concentration or memory
Feelings of low self-worth
Violent feelings

PMS-H (hydration) symptoms include the following:

Weight gain
Abdominal bloating
Breast tenderness
Swelling of extremities

PMS-O (other) symptoms include the following:

Dysmenorrhea
Change in bowel habits
Frequent urination
Hot flashes or cold sweats
General aches or pains
Nausea
Acne
Allergic reactions
Upper respiratory tract infections

Physical Examination

Usually, no physical findings are specifically helpful in establishing the diagnosis of PMS. If the adolescent presents during the luteal phase, she may have mastalgia or edema of the breasts or legs.^[18]

Differential Diagnoses

Freeman EW, Sondheimer SJ. Premenstrual Dysphoric Disorder: Recognition and Treatment. Prim Care Companion J Clin Psychiatry. 2003 Feb. 5 (1):30-39. [QxMD MEDLINE Link].
Hantsoo L, Epperson CN. Premenstrual Dysphoric Disorder: Epidemiology and Treatment. Curr Psychiatry Rep. 2015 Nov. 17 (11):87. [QxMD MEDLINE Link]. [Full Text].
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
Fathizadeh N, Ebrahimi E, Valiani M, Tavakoli N, Yar MH. Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iran J Nurs Midwifery Res. 2010 Dec. 15 (Suppl 1):401-5. [QxMD MEDLINE Link]. [Full Text].
Gynecologic pain: dysmenorrhea, acute and chronic pelvic pain, endometriosis, and premenstrual syndrome. Emans SJH, Laufer MR, eds. Emans, Laufer, Goldstein's Pediatric and Adolescent Gynecology. 6th ed. Philadelphia: Wolters Kluwer; 2012. Chap 13.
Gehlert S, Chang CH, Hartlage S. Symptom patterns of premenstrual dysphoric disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders-IV. J Womens Health. 1999 Jan-Feb. 8 (1):75-85. [QxMD MEDLINE Link].
Rossignol AM, Bonnlander H. Prevalence and severity of the premenstrual syndrome. Effects of foods and beverages that are sweet or high in sugar content. J Reprod Med. 1991 Feb. 36 (2):131-6. [QxMD MEDLINE Link].
Bertone-Johnson ER, Whitcomb BW, Missmer SA, Manson JE, Hankinson SE, Rich-Edwards JW. Early life emotional, physical, and sexual abuse and the development of premenstrual syndrome: a longitudinal study. J Womens Health (Larchmt). 2014 Sep. 23 (9):729-39. [QxMD MEDLINE Link]. [Full Text].
Bertone-Johnson ER, Hankinson SE, Johnson SR, Manson JE. Cigarette smoking and the development of premenstrual syndrome. Am J Epidemiol. 2008 Oct 15. 168 (8):938-45. [QxMD MEDLINE Link]. [Full Text].
Braverman PK. Premenstrual syndrome and premenstrual dysphoric disorder. J Pediatr Adolesc Gynecol. 2007 Feb. 20 (1):3-12. [QxMD MEDLINE Link].
Deuster PA, Adera T, South-Paul J. Biological, social, and behavioral factors associated with premenstrual syndrome. Arch Fam Med. 1999 Mar-Apr. 8 (2):122-8. [QxMD MEDLINE Link].
Masho SW, Adera T, South-Paul J. Obesity as a risk factor for premenstrual syndrome. J Psychosom Obstet Gynaecol. 2005 Mar. 26 (1):33-9. [QxMD MEDLINE Link].
Choi SH, Hamidovic A. Association between smoking and premenstrual syndrome: a meta-analysis. Front Psychiatry. 2020. 11:575526. [QxMD MEDLINE Link].
Cleckner-Smith CS, Doughty AS, Grossman JA. Premenstrual symptoms. Prevalence and severity in an adolescent sample. J Adolesc Health. 1998 May. 22 (5):403-8. [QxMD MEDLINE Link].
Nobles CJ, Thomas JJ, Valentine SE, Gerber MW, Vaewsorn AS, Marques L. Association of premenstrual syndrome and premenstrual dysphoric disorder with bulimia nervosa and binge-eating disorder in a nationally representative epidemiological sample. Int J Eat Disord. 2016 Jul. 49 (7):641-50. [QxMD MEDLINE Link].
Bertone-Johnson ER, Whitcomb BW, Rich-Edwards JW, Hankinson SE, Manson JE. Premenstrual Syndrome and Subsequent Risk of Hypertension in a Prospective Study. Am J Epidemiol. 2015 Dec 15. 182 (12):1000-9. [QxMD MEDLINE Link].
Freeman EW, DeRubeis RJ, Rickels K. Reliability and validity of a daily diary for premenstrual syndrome. Psychiatry Res. 1996 Nov 15. 65 (2):97-106. [QxMD MEDLINE Link].
Johnson SR. Premenstrual syndrome, premenstrual dysphoric disorder, and beyond: a clinical primer for practitioners. Obstet Gynecol. 2004 Oct. 104 (4):845-59. [QxMD MEDLINE Link].
Steiner M, Korzekwa M, Lamont J, Wilkins A. Intermittent fluoxetine dosing in the treatment of women with premenstrual dysphoria. Psychopharmacol Bull. 1997. 33 (4):771-4. [QxMD MEDLINE Link].
Forrester-Knauss C, Zemp Stutz E, Weiss C, Tschudin S. The interrelation between premenstrual syndrome and major depression: results from a population-based sample. BMC Public Health. 2011 Oct 12. 11:795. [QxMD MEDLINE Link]. [Full Text].
Sanfilippo JS, Muram D, Dewhurst J, Lee PA, eds. Pediatric and Adolescent Gynecology. 2nd ed. Philadelphia: Saunders; 2001. 433-50.
Freeman EW. Therapeutic management of premenstrual syndrome. Expert Opin Pharmacother. 2010 Dec. 11 (17):2879-89. [QxMD MEDLINE Link].
Maharaj S, Trevino K. A Comprehensive Review of Treatment Options for Premenstrual Syndrome and Premenstrual Dysphoric Disorder. J Psychiatr Pract. 2015 Sep. 21 (5):334-50. [QxMD MEDLINE Link].
Yonkers KA, Brown C, Pearlstein TB, Foegh M, Sampson-Landers C, Rapkin A. Efficacy of a new low-dose oral contraceptive with drospirenone in premenstrual dysphoric disorder. Obstet Gynecol. 2005 Sep. 106 (3):492-501. [QxMD MEDLINE Link].
Brown CS, Ling FW, Andersen RN, Farmer RG, Arheart KL. Efficacy of depot leuprolide in premenstrual syndrome: effect of symptom severity and type in a controlled trial. Obstet Gynecol. 1994 Nov. 84 (5):779-86. [QxMD MEDLINE Link].
Diegoli MS, da Fonseca AM, Diegoli CA, Pinotti JA. A double-blind trial of four medications to treat severe premenstrual syndrome. Int J Gynaecol Obstet. 1998 Jul. 62 (1):63-7. [QxMD MEDLINE Link].
Freeman EW, Rickels K. Characteristics of placebo responses in medical treatment of premenstrual syndrome. Am J Psychiatry. 1999 Sep. 156 (9):1403-8. [QxMD MEDLINE Link].
Freeman EW, Rickels K, Sondheimer SJ, Denis A, Pfeifer S, Weil S. Nefazodone in the treatment of premenstrual syndrome: a preliminary study. J Clin Psychopharmacol. 1994 Jun. 14 (3):180-6. [QxMD MEDLINE Link].
Jermain DM, Preece CK, Sykes RL, Kuehl TJ, Sulak PJ. Luteal phase sertraline treatment for premenstrual dysphoric disorder. Results of a double-blind, placebo-controlled, crossover study. Arch Fam Med. 1999 Jul-Aug. 8 (4):328-32. [QxMD MEDLINE Link].
Pearlstein TB, Bachmann GA, Zacur HA, Yonkers KA. Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation. Contraception. 2005 Dec. 72 (6):414-21. [QxMD MEDLINE Link].
Pearlstein TB, Stone AB, Lund SA, Scheft H, Zlotnick C, Brown WA. Comparison of fluoxetine, bupropion, and placebo in the treatment of premenstrual dysphoric disorder. J Clin Psychopharmacol. 1997 Aug. 17 (4):261-6. [QxMD MEDLINE Link].
Schmidt PJ, Nieman LK, Danaceau MA, Adams LF, Rubinow DR. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med. 1998 Jan 22. 338 (4):209-16. [QxMD MEDLINE Link].
Steinberg S, Annable L, Young SN, Liyanage N. A placebo-controlled clinical trial of L-tryptophan in premenstrual dysphoria. Biol Psychiatry. 1999 Feb 1. 45 (3):313-20. [QxMD MEDLINE Link].
Steiner M, Macdougall M, Brown E. The premenstrual symptoms screening tool (PSST) for clinicians. Arch Womens Ment Health. 2003 Aug. 6 (3):203-9. [QxMD MEDLINE Link].
Stevinson C, Ernst E. Complementary/alternative therapies for premenstrual syndrome: a systematic review of randomized controlled trials. Am J Obstet Gynecol. 2001 Jul. 185 (1):227-35. [QxMD MEDLINE Link].
Thys-Jacobs S, Starkey P, Bernstein D, Tian J. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Premenstrual Syndrome Study Group. Am J Obstet Gynecol. 1998 Aug. 179 (2):444-52. [QxMD MEDLINE Link].
Walker AF, De Souza MC, Vickers MF, Abeyasekera S, Collins ML, Trinca LA. Magnesium supplementation alleviates premenstrual symptoms of fluid retention. J Womens Health. 1998 Nov. 7 (9):1157-65. [QxMD MEDLINE Link].
Wilson SA. Calcium therapy for treating PMS. J Fam Pract. 1998 Dec. 47 (6):410-1. [QxMD MEDLINE Link].
Yakir M, Kreitler S, Brzezinski A, Vithoulkas G, Oberbaum M, Bentwich Z. Effects of homeopathic treatment in women with premenstrual syndrome: a pilot study. Br Homeopath J. 2001 Jul. 90 (3):148-53. [QxMD MEDLINE Link].
Yonkers KA, Halbreich U, Freeman E, Brown C, Endicott J, Frank E, et al. Symptomatic improvement of premenstrual dysphoric disorder with sertraline treatment. A randomized controlled trial. Sertraline Premenstrual Dysphoric Collaborative Study Group. JAMA. 1997 Sep 24. 278 (12):983-8. [QxMD MEDLINE Link].
Wyatt KM, Dimmock PW, Jones PW, Shaughn O'Brien PM. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ. 1999 May 22. 318 (7195):1375-81. [QxMD MEDLINE Link].
Wyatt KM, Dimmock PW, O'Brien PM. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2002. CD001396. [QxMD MEDLINE Link].
Halbreich U. Selective serotonin reuptake inhibitors and initial oral contraceptives for the treatment of PMDD: effective but not enough. CNS Spectr. 2008 Jul. 13 (7):566-72. [QxMD MEDLINE Link].
Romano S, Judge R, Dillon J, Shuler C, Sundell K. The role of fluoxetine in the treatment of premenstrual dysphoric disorder. Clin Ther. 1999 Apr. 21 (4):615-33; discussion 613. [QxMD MEDLINE Link].
Steiner M, Steinberg S, Stewart D, Carter D, Berger C, Reid R, et al. Fluoxetine in the treatment of premenstrual dysphoria. Canadian Fluoxetine/Premenstrual Dysphoria Collaborative Study Group. N Engl J Med. 1995 Jun 8. 332 (23):1529-34. [QxMD MEDLINE Link].
Young SA, Hurt PH, Benedek DM, Howard RS. Treatment of premenstrual dysphoric disorder with sertraline during the luteal phase: a randomized, double-blind, placebo-controlled crossover trial. J Clin Psychiatry. 1998 Feb. 59 (2):76-80. [QxMD MEDLINE Link].
Ford O, Lethaby A, Roberts H, Mol BW. Progesterone for premenstrual syndrome. Cochrane Database Syst Rev. 2012 Mar 14. 3:CD003415. [QxMD MEDLINE Link].
Marjoribanks J, Brown J, O'Brien PM, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2013 Jun 7. CD001396. [QxMD MEDLINE Link]. [Full Text].
Ismaili E, Walsh S, O'Brien PMS, Bäckström T, Brown C, Dennerstein L, et al. Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder. Arch Womens Ment Health. 2016 Dec. 19 (6):953-958. [QxMD MEDLINE Link].
Agha-Hosseini M, Kashani L, Aleyaseen A, Ghoreishi A, Rahmanpour H, Zarrinara AR, et al. Crocus sativus L. (saffron) in the treatment of premenstrual syndrome: a double-blind, randomised and placebo-controlled trial. BJOG. 2008 Mar. 115 (4):515-9. [QxMD MEDLINE Link].
Budeiri D, Li Wan Po A, Dornan JC. Is evening primrose oil of value in the treatment of premenstrual syndrome?. Control Clin Trials. 1996 Feb. 17 (1):60-8. [QxMD MEDLINE Link].
Chou PB, Morse CA, Xu H. A controlled trial of Chinese herbal medicine for premenstrual syndrome. J Psychosom Obstet Gynaecol. 2008 Sep. 29 (3):185-92. [QxMD MEDLINE Link].
Bertone-Johnson ER, Chocano-Bedoya PO, Zagarins SE, Micka AE, Ronnenberg AG. Dietary vitamin D intake, 25-hydroxyvitamin D3 levels and premenstrual syndrome in a college-aged population. J Steroid Biochem Mol Biol. 2010 Jul. 121 (1-2):434-7. [QxMD MEDLINE Link].
Evans SM, Foltin RW, Fischman MW. Food "cravings" and the acute effects of alprazolam on food intake in women with premenstrual dysphoric disorder. Appetite. 1999 Jun. 32 (3):331-49. [QxMD MEDLINE Link].
Girman A, Lee R, Kligler B. An integrative medicine approach to premenstrual syndrome. Am J Obstet Gynecol. 2003 May. 188 (5 Suppl):S56-65. [QxMD MEDLINE Link].
El-Lithy A, El-Mazny A, Sabbour A, El-Deeb A. Effect of aerobic exercise on premenstrual symptoms, haematological and hormonal parameters in young women. J Obstet Gynaecol. 2015 May. 35 (4):389-92. [QxMD MEDLINE Link].
Yesildere Saglam H, Orsal O. Effect of exercise on premenstrual symptoms: a systematic review. Complement Ther Med. 2020 Jan. 48:102272. [QxMD MEDLINE Link].
Jarvis CI, Lynch AM, Morin AK. Management strategies for premenstrual syndrome/premenstrual dysphoric disorder. Ann Pharmacother. 2008 Jul. 42 (7):967-78. [QxMD MEDLINE Link].
Sharma B, Misra R, Singh K, Sharma R, Archana. Comparative study of effect of anuloma-viloma (pranayam) and yogic asanas in premenstrual syndrome. Indian J Physiol Pharmacol. 2013 Oct-Dec. 57 (4):384-9. [QxMD MEDLINE Link].

Media Gallery

of 0

Author

Megan A Moreno, MD, MSEd, MPH Professor, Interim Chair, Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health

Megan A Moreno, MD, MSEd, MPH is a member of the following medical societies: Society for Adolescent Health and Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Ann E Giesel, MD Clinical Professor of Pediatrics, Division of Adolescent Medicine, University of Washington; Director of Pediatric and Adolescent Gynecology, Seattle Children's Hospital; Medical Director of the King County Juvenile Detention Center Health Clinic; Medical Director of the Evevning Clinics at the Country Free Doctor FreeTeen Clinic for Homeless Youth

Ann E Giesel, MD is a member of the following medical societies: North American Society for Pediatric and Adolescent Gynecology, Society for Adolescent Health and Medicine, Washington State Medical Association

Disclosure: Nothing to disclose.

Cara Beth Rogers University of Rochester

Disclosure: Nothing to disclose.

Liana Roxanne Clark, MD, MS Assistant Professor, Department of Pediatrics, Craig-Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia; Medical Director, Global Medical Affairs and Policy, Merck Vaccines

Liana Roxanne Clark, MD, MS is a member of the following medical societies: American Academy of Pediatrics, Society for Adolescent Health and Medicine

Disclosure: Received salary from Merck & Co. Inc for employment. for: Merck & Co., Inc.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center; Chairman, Pediatric Institutional Review Board, Mercy St Vincent Medical Center, Toledo, Ohio

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Andrea L Zuckerman, MD Associate Professor of Obstetrics/Gynecology, Tufts University School of Medicine; Division Director, Pediatric and Adolescent Gynecology, Tufts Medical Center

Andrea L Zuckerman, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Massachusetts Medical Society, North American Society for Pediatric and Adolescent Gynecology

Disclosure: Nothing to disclose.

Additional Contributors

Elizabeth Alderman, MD Director, Pediatric Residency Program, Director of Fellowship Training Program, Adolescent Medicine, Professor of Clinical Pediatrics, Department of Pediatrics, Division of Adolescent Medicine, Albert Einstein College of Medicine and Children's Hospital at Montefiore

Elizabeth Alderman, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, North American Society for Pediatric and Adolescent Gynecology, Society for Adolescent Health and Medicine

Disclosure: Nothing to disclose.

Premenstrual Syndrome Clinical Presentation

History

Physical Examination

References

Tables

Contributor Information and Disclosures

What would you like to print?