Updated insight into the pathophysiology of premenstrual dysphoric disorder and therapeutic approaches

Premenstrual Dysphoric Disorder (PMDD) is a debilitating menstrual cycle-related condition that emerges during the luteal phase preceding menstruation and is characterized by pronounced mood disturbances accompanied by associated physical symptoms. PMDD involves dysregulation of hormones and neurotransmitters, influenced by genetic, psychosocial, immune, and opioid factors that contribute to symptom severity. Given the substantial impact of PMDD symptoms, including mood changes, sleep disturbances, and disordered eating, on women's daily lives, further investigation into its underlying mechanisms is essential. The investigation of genetic influences and their interplay with hormonal and neurotransmitter dynamics in PMDD remains nascent, with limited research conducted in this domain. However, several pharmacological and surgical treatment options are available for PMDD, including SSRIs, hormonal therapies, GnRH agonists, SPRMs, sepranolone (UC1010), and, in severe cases, surgical menopause. These therapies seek to mitigate symptoms by correcting hormonal and neurotransmitter abnormalities. This narrative review provides a comprehensive overview of PMDD, encompassing its pathophysiology, etiology, clinical manifestations, epidemiology, prognosis, and current therapeutic strategies.