Premenstrual syndrome (PMS/PMDD)

Definition

• Premenstrual syndrome comprises mood, behavioural and physical symptoms that begin in the luteal phase about 1 to 2 weeks before menstruation and resolve shortly after bleeding starts.
• Premenstrual dysphoric disorder is the most severe form and is classified among the depressive disorders in DSM-5.

Occurrence & epidemiology

Epidemiology

• Most women of reproductive age experience at most mild premenstrual discomfort; 5–8% develop moderate to severe symptoms with significant impairment.
• The prevalence of PMDD among women of reproductive age in the United States is given as about 2–6%; global estimates vary widely.

Aetiopathogenesis

Aetiology and pathogenesis

• The cause is unclear; an individually increased sensitivity to normal cyclical hormonal fluctuations is assumed, involving progesterone metabolites such as allopregnanolone and the GABAergic and serotonergic systems.

Clinical features

• Physical symptoms include breast tenderness, headache, joint or muscle pain, bloating and weight gain.
• Core psychological symptoms are depressed mood, anxiety and tension, affective lability and irritability or anger; irritability is among the most common symptoms.

Diagnosis

• For PMDD, DSM-5 requires at least 5 of 11 symptoms, including at least 1 of the 4 core symptoms, in most menstrual cycles of the preceding year.
• Symptoms occur in the final week before menstruation and resolve in the week after; this is confirmed by prospective daily symptom ratings over at least 2 consecutive cycles.

Keep learning in the app

Further reading (selection)

1. StatPearls: Premenstrual Disorders (NCBI Bookshelf)
2. MSD Manual Professional: Premenstrual Syndrome (PMS)
3. Premenstrual Disorders in Adolescents: An Interdisciplinary Perspective (J Clin Med 2026, PubMed Central)

Cross-references