Premenstrual dysphoric disorder: evaluation, pathophysiology and treatment

Area of Science:

• Reproductive psychiatry
• Women's health
• Mood disorders

Background:

• Premenstrual dysphoric disorder (PMDD) is a severe condition characterized by dysphoric disturbance during the premenstrual week.
• PMDD significantly impairs social, occupational, and domestic functioning.
• It requires differentiation from minor premenstrual changes, dysmenorrhea, and exacerbations of existing psychiatric conditions.

Purpose of the Study:

• To review the diagnostic criteria and current understanding of premenstrual dysphoric disorder (PMDD).
• To examine the etiological theories and methodological limitations in PMDD research.
• To evaluate the efficacy of current treatment strategies for PMDD.

Main Methods:

• Prospective symptom assessment over at least two menstrual cycles is crucial for diagnosis.
• Review of existing literature on pathophysiology, etiology, and treatment of PMDD.
• Analysis of controlled and uncontrolled studies on pharmacological and non-pharmacological interventions.

Main Results:

• The pathophysiology of PMDD is linked to the hypothalamo-pituitary-gonadal axis, but etiological theories lack widespread support due to methodological weaknesses in studies.
• No single pharmacological treatment has demonstrated superior efficacy over placebo in controlled trials.
• Uncontrolled studies suggest PMDD responds favorably to various interventions.

Conclusions:

• Accurate diagnosis of PMDD requires careful prospective assessment.
• Current understanding of PMDD etiology is limited by study design.
• While interrupting the menstrual cycle can alleviate symptoms, such treatments require further safety evaluation before general recommendation.