Premenstrual dysphoric disorder: burden of illness and treatment update

Premenstrual dysphoric disorder: burden of illness and treatment update


J Psychiatry Neurosci 2008;33(4):291-301

Teri Pearlstein, MD; Meir Steiner, MD, PhD

Pearlstein — Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University and Women’s Behavioral Health Program, Women and Infants Hospital, Providence, RI; Steiner — Departments of Psychiatry and Behavioral Neurosciences and Obstetrics and Gynecology, McMaster University, Brain–Body Institute, Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, Ont., Department of Psychiatry and Institute of Medical Sciences, University of Toronto, The Hospital for Sick Children, Toronto, Ont.


Five percent of menstruating women have severe premenstrual symptoms and impairment of functioning defined as premenstrual dysphoric disorder (PMDD). Clinically significant premenstrual symptoms occur in at least an additional 20% of menstruating women. The diagnosis of PMDD should be confirmed by prospective symptom charting over 2 menstrual cycles to confirm the timing of the symptoms and to rule out other diagnoses. The burden of illness of PMDD includes disruption of parenting and partner relationships and decreased productivity in work roles. In addition, women with PMDD have increased use of health care services such as clinician visits and increased use of prescription medications and over-the-counter preparations. The etiology of PMDD is multifactorial. In particular, dysregulation of the serotonin and allopregnanolone systems is implicated. Several effective treatment options exist, including serotonergic antidepressant medications and an oral contraceptive that contains ethinyl estradiol and drosperinone. In addition, other hormones that suppress ovulation, anxiolytics, cognitive therapy, chasteberry and calcium may be helpful.


Cinq pour cent des femmes menstruées ont des symptômes prémenstruels sévères et une incapacité du fonctionnement appelée trouble dysphorique prémenstruel (TDPM). Au moins 20 % de femmes menstruées de plus ont des symptômes prémenstruels cliniquement significatifs. Il faut confirmer le diagnostic de TDPM en suivant les symptômes de façon prospective au cours de deux cycles menstruels afin de confirmer le moment de l’apparition des symptômes et d’exclure d’autres diagnostics. Le fardeau morbide imposé par le TDPM comprend la perturbation des relations avec les enfants et le partenaire et une baisse de productivité au travail. Les femmes atteintes de TDPM ont en outre recours davantage aux services de santé comme les visites aux cliniciens et prennent davantage de médicaments d’ordonnance et en vente libre. L’étiologie du TDPM est multifactorielle. La dysrégulation des systèmes de la sérotonine et de l’allopregnanolone en particulier est mise en cause. Il existe plus d’un traitement efficace possible, y compris des antidépresseurs sérotoninergiques et un contraceptif oral qui contient de l’éthinyloestradiol et de la drosperinone. D’autres hormones qui bloquent l’ovulation, des anxiolytiques, la thérapie cognitive, le gattilier (Vitex agnus castus) et le calcium peuvent en outre aider.

Medical subject headings: premenstrual syndrome; contraceptives, oral; serotonin uptake inhibitors; treatment.

Competing interests: Dr. Pearlstein has been as a paid consultant for Wyeth Pharmaceuticals and has received speakers fees from Bayer. Dr. Steiner is a consultant with GlaxoSmithKline, Wyeth Pharmaceuticals, Bayer Shering Pharmaceuticals, AstraZeneca and Azevan Pharmaceuticals. He currently has grant/research support from Wyeth, GlaxoSmithKline, AstraZeneca and Lundbeck and has received honoraria from Ortho-McNeil and Azevan Pharmaceuticals.

Contributors: Both authors designed the study. Dr. Pearlstein analyzed the data and wrote the article, and Dr. Steiner revised it. Both authors gave final approval for the article to be published.

Submitted June 20, 2007; Revised Aug. 2, 2007; Accepted Aug. 3, 2007

Correspondence to: Dr. T. Pearlstein, Women and Infants Hospital, 101 Dudley St., Providence RI 02905; fax 401 453-7720;