Differentials
Depression
SIGNS / SYMPTOMS
Patient meets Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria for major depression. Depression symptoms include low mood, low energy, anhedonia, appetite change, sleep disturbance, difficulty in concentrating, psychomotor agitation or retardation, feelings of worthlessness or excessive or inappropriate guilt, and thoughts of suicide.
Depression may co-exist with PMS or PMDD in up to 50% of cases.[33] A diagnosis of PMS or PMDD may pre-date a diagnosis of depression.[33] Major depression and PMDD may co-exist. Criteria are different but not exclusive.
INVESTIGATIONS
Diagnosis is clinical.
Thyroid disease
SIGNS / SYMPTOMS
Hypothyroid symptoms and signs include weight gain, constipation, cold intolerance, depression, dry skin, and delayed deep tendon reflexes.
Hyperthyroid signs and symptoms include weight loss, poor sleep, heat intolerance, heart rhythm disturbance such as atrial fibrillation, and hyper-reflexia.
INVESTIGATIONS
Thyroid blood tests may show abnormalities reflecting an overactive or underactive thyroid.
Generalised anxiety disorder
SIGNS / SYMPTOMS
Patient meets Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria for generalised anxiety disorder. Symptoms of anxiety include palpitations and feelings of fear. Triggers may be identified for anxiety attacks, and patient shows avoidance of these triggers.
Chronic or situational anxiety does not vary with the menstrual cycle.
Generalised anxiety disorder and PMDD may co-exist. Criteria are different but not exclusive.
INVESTIGATIONS
Diagnosis is clinical.
Mastalgia
SIGNS / SYMPTOMS
Symptoms may be limited to breast tenderness and swelling, in which case mastalgia should be considered.
Mastalgia may be present other than during the menstrual cycle but worsens during the luteal phase.
INVESTIGATIONS
Diagnosis is clinical.
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