practical information on diagnosis and treatment for use by practitioners Premenstrual Syndrome, Premenstrual Dysphoric Disorder, and Beyond: A Clinical Primer for Practitioners

The management of adverse premenstrual symptoms has presented a difficult challenge for clinicians. However, based on numerous well-designed research studies over the last decade, we now have diagnostic criteria for the severe form of the syndrome, premenstrual dysphoric disorder, and a variety of evidence-based therapeutic strategies. This review presents a comprehensive, practical description of what the clinician needs to know to diagnose and treat adverse premenstrual symptoms at all levels of severity. Diagnostic criteria are described in detail, including a dis-cussion of the distinction between premenstrual dysphoric disorder and premenstrual syndrome (PMS). The ratio-nale for including prospective symptom calendars as a routine part of the diagnostic evaluation of severe symp-toms is presented. The differential diagnosis of cyclic symp-toms, including depression and anxiety disorders, men-strual migraine, and mastalgia, and an approach for the management of each of these problems are presented. A treatment approach is recommended that matches the treatment to the degree of problems the woman is experi-encing. Serotonin reuptake inhibitors are the treatment of choice for severe symptoms, and most women with PMS/ premenstrual dysphoric disorder will respond to intermit-tent, luteal phase–only therapy. Ovulation suppression should be reserved for women who do not respond to other forms of therapy. The role of oophorectomy is limited, and guidelines for its use are presented. (Obstet Gyneco