History and exam

Key diagnostic factors

common

presence of risk factors

Key risk factors include post-pubescent and premenopausal women, family history, and mood disorders.

abdominal bloating

Abdominal bloating several days before menses that resolves at the beginning of menses. Occurs in 90% of women with PMS or PMDD.[20][21]​​​[57][58]

fatigue

Feeling of fatigue or lack of energy and tiredness and reduced productivity. Occurs in most women with PMS or PMDD.[20][21]​​​[57][58]

breast tenderness

Breast tenderness before menses. Occurs in 50% of women with PMS or PMDD.[20][21]​​​[57][58]

headaches

More headaches, usually like tension headaches, before menses. Occurs in 50% of women with PMS or PMDD.[20][21]​​​[57][58]

depressed mood, irritability, and internal tension

Feelings of hopelessness or self-deprecating thoughts; stress just before menses. Interest in normal activities is lost. Occurs in 70% of women with PMDD.[20][21]​​​[57][58]

labile mood

Patient or those who live with her report mood swings and being upset easily, just before menses. Occurs in 80% of women with PMS or PMDD.[20][21]​​​[57][58]

adverse effect on life

Patient describes how premenstrual symptoms affect own and family members' lives adversely.[20][21]​​​[57][58]

Other diagnostic factors

common

increased appetite

Specific food cravings and increased appetite are evident. Occurs in 70% of women with PMS or PMDD.[20][21]​​​[57][58]

forgetfulness and difficulty concentrating

Patient reports being more forgetful, with poorer concentration and lower performance at work or school, just before menses. Occurs in 50% of women with PMS or PMDD.[20][21]​​​[57][58]

other subjective symptoms

Feeling of being out of control, overwhelmed, or agitated.[20][21]​​​[57][58]

uncommon

insomnia or hypersomnia

Increased sleep or difficulty sleeping before or during menses. Occurs in some women with PMS or PMDD.[20][21]​​​[57][58]

gastrointestinal upset

Loose stools or constipation, or a change in usual bowel habit, just before menses. Occurs in 15% to 20% of women with PMS or PMDD.[20][21]​​​[57][58]

heart palpitations

Intermittent heart palpitations just before menses. Occurs in 15% to 20% of women with PMS or PMDD.[20][21]​​​[57][58]

hot flushes

Feeling of hot flushes just before menses. Occurs in 15% to 20% of women with PMS or PMDD.[20][21]​​​[57][58]

Risk factors

strong

post-pubescent and premenopausal women

Ovulatory cycles seem to be a prerequisite for PMS/PMDD; therefore, the strongest risk factor for PMS/PMDD is the presence of ovulatory menstrual cycles.[7]

weak

family history

There may be a familial risk of PMS/PMDD, as suggested by twin studies.[31]

mood disorders

A history of major depression has been associated with PMDD.[51]

PMS or PMDD may be a precursor to major depression. A diagnosis of PMDD may also follow a diagnosis of depression. Serotonin neurotransmitters have been implicated, because both conditions respond to selective serotonin-reuptake inhibitors.[52][53]

cigarette smoking

Has been associated with increased risk of PMDD.[51]

white women

In the US, PMS/PMDD is more prevalent in white women than in black women.[13] However, black, indigenous, and other people of colour are significantly underrepresented in studies on premenstrual disorders.[1]​ Moreover, diagnostic criteria used for these studies differ, making a direct comparison of prevalence among different ethnicities challenging.[8][9][10]​​

sexual abuse and/or trauma

Early sexual abuse and trauma also appears to confer risk.[54][55]

alcohol consumption

Any alcohol consumption is associated with an increased risk of PMS/PMDD (odds ratio [OR] 1.45, 95% confidence interval [CI] 1.17 to 1.79). Heavy drinking is associated with a higher risk than any drinking (OR 1.79, 95% CI 1.39 to 2.32).[30]

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