Criteria

American College of Obstetricians and Gynecologists criteria for premenstrual tension syndrome[4]

The healthcare provider must confirm a pattern of symptoms. These symptoms must:

  1. Be present in the 5 days before the woman's period for at least 3 menstrual cycles in a row

  2. End within 4 days after her period starts

  3. Interfere with some of her normal activities.

Royal College of Obstetricians and Gynaecologists criteria for premenstrual syndrome[7]

  1. Timing, rather than the types of symptoms, supports a diagnosis of PMS. The symptoms should be cyclical and relieved by menstruation.

  2. There should be 1 symptom-free week.

  3. Symptoms affect quality of life.

  4. There are no other factors.

International statistical classification of diseases and related health problems, 11th revision (ICD-11): GA34.40 Premenstrual tension syndrome[59]

A syndrome affecting females that is frequently idiopathic. This syndrome is characterized by certain environmental, metabolic, or behavioral factors that occur during the luteal phase of the menstrual cycle, and leads to cyclic emotional, physical, or behavioral symptoms that interfere with an individual's lifestyle. Confirmed by documentation of specific cyclic symptoms associated with the luteal and menstrual phases of the cycle (from a prospective symptom diary), and evidence of socioeconomic dysfunction.

ICD-11 recognizes as disorders:

  • Premenstrual tension syndrome

  • Premenstrual disturbances, unspecified

  • Premenstrual dysphoric disorder (PMDD)

  • Other specified premenstrual disturbances

  • Premenstrual symptom or complaint.

ICD-11 criteria for PMDD:

During a majority of menstrual cycles within the past year, a pattern of:

  • Mood symptoms (depressed mood, irritability)

  • Somatic symptoms (lethargy, joint pain, overeating); and/or

  • Cognitive symptoms (concentration difficulties, forgetfulness)

That:

  • Begin several days before the onset of menses

  • Start to improve within a few days after the onset of menses

  • Become minimal or absent within approximately 1 week following the onset of menses

And:

  • Should ideally be confirmed by a prospective symptom diary over at least 2 symptomatic menstrual cycles to confirm temporal relationship

  • Are severe enough to cause significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning

  • Do not represent the exacerbation of a mental disorder.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria for PMDD[5]

  1. These criteria require prospective documentation of physical and behavioral symptoms (using diaries) for at least 2 months. Symptoms should have been present for most menstrual cycles of the preceding year.

  2. Five or more symptoms must have been present during the week prior to menses, improve within a few days after the onset of menses, and become minimal or absent in the week post-menses.

  3. PMDD may be superimposed on other psychiatric disorders, as long as it is not merely an exacerbation of those disorders.

Within the five symptoms, at least one of the following symptoms must be present:

  • Mood swings, sudden sadness, increased sensitivity to rejection

  • Anger, irritability, or increased interpersonal conflicts

  • Sense of hopelessness, depressed mood, self-critical thoughts

  • Tension, anxiety, feeling on edge.

And at least one of the following symptoms must be present:

  • Difficulty concentrating

  • Change in appetite, food cravings, overeating

  • Diminished interest in usual activities

  • Easily fatigued, decreased energy, or lethargy

  • Feeling overwhelmed or out of control

  • Breast tenderness or swelling, bloating, weight gain, or joint/muscles aches

  • Sleeping too much or not sleeping enough.

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