Premenstrual syndrome and dysphoric disorder

Case history

A 32-year-old single woman with no prior pregnancy presents for her annual wellness examination. She reports recurrent symptoms of fatigue, abdominal bloating, breast tenderness, increased appetite, and irritability that have occurred for many years, predominantly 1 week before the start of menses. The symptoms improved when she was on oral contraceptives during her 20s but recently have become more troublesome, interfering with her interpersonal relationships and her ability to perform optimally at work as a research assistant. Her last menstrual period ended 1 week ago. Physical examination reveals normal findings with normal breast and pelvic examination. She does not meet clinical criteria for depression.