CNS Drugs

, Volume 13, Issue 4, pp 287–304

Advances in the Diagnosis and Treatment of Premenstrual Dysphoria

Review Article


The recent inclusion of research diagnostic criteria for premenstrual dysphoric disorder (PMDD) in the DSM-IV recognises the fact that some women in their reproductive years have extremely distressing emotional and behavioural symptoms premenstrually. Through the use of these criteria, PMDD can be differentiated from premenstrual syndrome (PMS) which has milder physical symptoms, i.e. breast tenderness, bloating, headache and minor mood changes. PMDD can also be differentiated from premenstrual exacerbation of a current psychiatric disorder or medical condition, although some women may meet criteria for a dual diagnosis.

Epidemiological surveys have estimated that as many as 75% of women with regular menstrual cycles experience some symptoms of PMS. PMDD, on the other hand, is much less common. It affects only 3 to 8% of women in this group, but it is more severe and exerts a much greater psychological toll. These women report premenstrual symptoms that seriously interfere with their lifestyle and relationships. The aetiology of PMDD is largely unknown but the current consensus seems to be that normal ovarian function (rather than hormone imbalance) is the cyclical trigger for PMDD-related biochemical events within the CNS and other target organs.

The serotonergic system is in close reciprocal relationship with the gonadal hormones and has been identified as the most plausible target for interventions. Thus, beyond the conservative treatment options such as lifestyle and stress management, and the more extreme interventions that eliminate ovulation altogether, the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs) are emerging as the most effective treatment options for this population.

Results from several randomised placebo-controlled trials in women with PMDD, with predominantly psychological symptoms of irritability, tension, dysphoria and lability of mood, have clearly demonstrated that the SSRIs have excellent efficacy and minimal adverse effects. More recently, several preliminary studies indicate that intermittent (premenstrually only) treatment with SSRIs is equally effective in these women and, thus, may offer an attractive treatment option for a disorder that is itself intermittent.


  1. 1.
    Endicott J, Amsterdam, J, Eriksson E, et al. Is premenstrual dysphoric disorder a distinct clinical entity? J Women’s Health Gender-Based Med 1999; 8: 663–79CrossRefGoogle Scholar
  2. 2.
    World Health Organization. Tenth revision of the International Classification of Diseases (ICD-10). Geneva: World Health Organization Publishers, 1996: 717Google Scholar
  3. 3.
    Budeiri DJ, Li Wan Po A, Dornan JC. Clinical trials of treatments of premenstrual syndrome: entry criteria and scales for measuring treatment outcomes. Br J Obstet Gynaecol 1994; 101:689–95PubMedCrossRefGoogle Scholar
  4. 4.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd rev. ed. Washington, DC: American Psychiatric Association, 1987: 367–9Google Scholar
  5. 5.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994: 717–8Google Scholar
  6. 6.
    Steiner M, Wilkins A, Diagnosis and assessment of premenstrual dysphoria. Psychiatr Ann 1996; 26: 571–5Google Scholar
  7. 7.
    Johnson SR. The epidemiology and social impact of premenstrual symptoms. Clin Obstet Gynecol 1987; 30: 367–76PubMedCrossRefGoogle Scholar
  8. 8.
    Greene R, Dalton K. The premenstrual syndrome. BMJ 1953; 1: 1007–14PubMedCrossRefGoogle Scholar
  9. 9.
    Haskett RF, DeLongis A, Kessler RC. Premenstrual dysphoria: a community survey. Presented at Annual American Psychiatric Association Meeting: 1987 May; ChicagoGoogle Scholar
  10. 10.
    Johnson SR, McChesney C, Bean JA. Epidemiology of premenstrual symptoms in a nonclinical sample. I. Prevalence, natural history and help-seeking behaviour. J Reprod Med 1988; 33: 340–6PubMedGoogle Scholar
  11. 11.
    Rivera-Tovar AD, Frank E. Late luteal phase dysphoric disorder in young women. Am J Psychiatry 1990; 147: 1634–6PubMedGoogle Scholar
  12. 12.
    Andersch B, Wendestam C, Hahn L, et al. Premenstrual complaints. I. Prevalence of premenstrual symptoms in a Swedish urban population. J Psychosom Obstet Gynaecol 1986; 5: 39–49CrossRefGoogle Scholar
  13. 13.
    Merikangas KR, Foeldenyi M, Angst J. The Zurich Study. XIX. Patterns of menstrual disturbances in the community: results of the Zurich Cohort Study. Eur Arch Psychiatry Clin Neurosci 1993; 243: 23–32PubMedCrossRefGoogle Scholar
  14. 14.
    Ramcharan S, Love EJ, Fick GH, et al. The epidemiology of premenstrual symptoms in a population based sample of 2650 urban women. J Clin Epidemiol 1992; 45: 377–81PubMedCrossRefGoogle Scholar
  15. 15.
    Freeman EW, Sondheimer K, Weinbaum PH, et al. Evaluating premenstrual symptoms in medical practice. Obstet Gynecol 1985; 65: 500–5PubMedGoogle Scholar
  16. 16.
    O’Brien PMS, Abukhalil IEH, Henshaw C. Premenstrual syndrome. Curr Obstet Gynecol 1995; 5: 30–7CrossRefGoogle Scholar
  17. 17.
    Hendrick V, Altshuler LL, Burt VK. Course of psychiatric disorders across the menstrual cycle. Harv Rev Psychiatry 1996; 4: 200–7PubMedCrossRefGoogle Scholar
  18. 18.
    Bailey JW, Cohen LS. Prevalence of mood and anxiety disorders in women who seek treatment for premenstrual syndrome. J Womens Health Gend Based Med 1999; 8:1181–4PubMedCrossRefGoogle Scholar
  19. 19.
    Blehar MC, DePauloJr JR, Gershon ES, et al. Women with bipolar disorder: findings from the NIMH Genetics Initiative sample. Psychopharmacol Bull 1998; 34: 239–43PubMedGoogle Scholar
  20. 20.
    Yonkers KA. The association between premenstrual dysphoric disorder and other mood disorders. J Clin Psychiatry 1997; 58 Suppl. 15: 19–25PubMedGoogle Scholar
  21. 21.
    Yonkers KA. Anxiety symptoms and anxiety disorders: how are they related to premenstrual disorders. J Clin Psychiatry 1997; 58 Suppl. 3: 62–7PubMedGoogle Scholar
  22. 22.
    Freeman EW, Rickels K, Schweizer E, et al. Relationships between age and symptom severity among women seeking medical treatment for premenstrual symptoms. Psychol Med 1995; 25: 309–15PubMedCrossRefGoogle Scholar
  23. 23.
    Deuster PA, Adera T, South-Paul J. Biological, social, and behavioral factors associated with premenstrual syndrome. Arch Fam Med 1999; 8: 122–8PubMedCrossRefGoogle Scholar
  24. 24.
    Woods NF, Most A, Dery GK. Prevalence of perimenstrual symptoms. Am J Public Health 1982; 72: 1257–64PubMedCrossRefGoogle Scholar
  25. 25.
    Hargrove JT, Abraham GE. The incidence of premenstrual tension in a gynecologic clinic. J Reprod Med 1982; 27: 721–4PubMedGoogle Scholar
  26. 26.
    Pearlstein TB, Frank E, Rivera-Tovar A, et al. Prevalence of axis I and axis II disorders in women with late luteal phase dysphoric disorder. J Affect Disord 1990; 20: 129–34PubMedCrossRefGoogle Scholar
  27. 27.
    Parry BL. Mood disorders linked to reproductive cycle in women. In: Bloom FE, Kupfer DJ, editors. Psychopharmacology: the fourth generation of progress. New York (NY): Raven Press, 1995: 1029–42Google Scholar
  28. 28.
    Harrison WM, Endicott J, Nee J, et al. Characteristics of women seeking treatment for premenstrual syndrome. Psychosomatics 1989; 30: 405–11PubMedCrossRefGoogle Scholar
  29. 29.
    Fava M, Pedrazzi F, Guaraldi GP, et al. Comorbid anxiety and depression among patients with late luteal phase dysphoric disorder. J Anxiety Disord 1992; 6: 325–35CrossRefGoogle Scholar
  30. 30.
    McLeod DR, Hoehn-Saric R, Foster GV, et al. The influence of premenstrual syndrome on ratings of anxiety in women with generalized anxiety disorder. Acta Psychiatr Scand 1993; 88: 248–51PubMedCrossRefGoogle Scholar
  31. 31.
    Endicott J. The menstrual cycle and mood disorders. J Affect Disord 1993; 29: 193–200PubMedCrossRefGoogle Scholar
  32. 32.
    Bancroft J, Rennie D, Warner P. Vulnerability to perimenstrual mood change: the relevance of a past history of depressive disorder. Psychosom Med 1994; 56: 225–31PubMedGoogle Scholar
  33. 33.
    Kaspi SP, Otto MW, Pollack MH, et al. Premenstrual exacerbation of symptoms in women with panic disorder. J Anxiety Disord 1994; 8: 131–8CrossRefGoogle Scholar
  34. 34.
    Graze KK, Nee J, Endicott J. Premenstrual depression predicts future major depressive disorder. Acta Psychiatr Scand 1990; 81:201–5PubMedCrossRefGoogle Scholar
  35. 35.
    Condon JT. The premenstrual syndrome: a twin study. Br J Psychiatry 1993; 162:481–6PubMedCrossRefGoogle Scholar
  36. 36.
    Kendler KS, Karkowski LM, Corey LA, et al. Longitudinal population-based twin study of retrospectively reported premenstrual symptoms and lifetime major depression. Am J Psychiatry 1998; 155: 1234–40PubMedGoogle Scholar
  37. 37.
    Severino SK, Moline ML. Premenstrual syndrome: a clinician’s guide. York (NY): The Guilford Press 1989: 132–5Google Scholar
  38. 38.
    Paddison PL, Gise LH, Lebovits A, et al. Sexual abuse and premenstrual syndrome: comparison between a lower and higher socioeconomic group. Psychosomatics 1990; 31: 265–72PubMedCrossRefGoogle Scholar
  39. 39.
    Dan AJ, Monagle L. Sociocultural influences on women’s experiences of perimenstrual symptoms. In: Gold JH, Severino SK, editors. Premenstrual dysphorias: myths and realities. Washington, DC: American Psychiatric Press, Inc., 1994: 201–11Google Scholar
  40. 40.
    Chandra PS, Chaturvedi SK. Cultural variations in premenstrual experience. Int J Soc Psychiatry 1989; 35(4): 343–9PubMedCrossRefGoogle Scholar
  41. 41.
    Chang AM, Holroyd E, Chau JP. Premenstrual syndrome in employed Chinese women in Hong Kong. Health Care Women Int 1995; 16: 551–61PubMedCrossRefGoogle Scholar
  42. 42.
    Sveinsdottir H. Prospective assessment of menstrual and premenstrual experiences of Icelandic women. Health Care Women Int 1998; 19: 71–82PubMedCrossRefGoogle Scholar
  43. 43.
    Marvan ML, Diaz-Erosa M, Montesinos A. Premenstrual symptoms in Mexican women with different educational levels. J Psychol 1998; 132: 517–26PubMedCrossRefGoogle Scholar
  44. 44.
    Schmidt PJ, Nieman LK, Danaceau MA, et al. Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med 1998; 338: 209–16PubMedCrossRefGoogle Scholar
  45. 45.
    Casson P, Hahn PM, Van Vugt DA, et al. Lasting response to ovariectomy in severe intractable premenstrual syndrome. Am J Obstet Gynecol 1990; 162: 99–105PubMedGoogle Scholar
  46. 46.
    Casper RF, Hearn MT. The effect of hysterectomy and bilateral oophorectomy in women with severe premenstrual syndrome. Am J Obstet Gynecol 1990; 162: 105–9PubMedGoogle Scholar
  47. 47.
    Roca CA, Schmidt PJ, Bloch M, et al. Implications of endocrine studies of premenstrual syndrome. Psychiatr Ann 1996; 26: 576–80Google Scholar
  48. 48.
    Rubinow DR, Schmidt PJ. The treatment of premenstrual syndrome — forward into the past. N Engl J Med 1995; 332: 1574–5PubMedCrossRefGoogle Scholar
  49. 49.
    Eriksson E, Sundblad C, Lisjo P, et al. Serum levels of androgens are higher in women with premenstrual irritability and dysphoria than in controls. Psychoneuroendocrinol 1992; 17: 195–204CrossRefGoogle Scholar
  50. 50.
    Eriksson E, Ailing C, Andersch B, et al. Cerebrospinal fluid levels of monoamine metabolites. Apreliminary study of their relation to menstrual cycle phase, sex steroids, and pituitary hormones in healthy women and in women with premenstrual syndrome. Neuropsychopharmacol 1994; 11: 201–13CrossRefGoogle Scholar
  51. 51.
    Steiner M, Coote M, Wilkins A, et al. Biological correlates of irritability in women with premenstrual dysphoria [abstract]. Eur Neuropsychopharmacol 1997; 7 Suppl. 2: S172CrossRefGoogle Scholar
  52. 52.
    Eriksson E, Sundblad C, Landén M, et al. Behavioural effects of androgens in women. In: Steiner M, Yonkers K, Eriksson E, editors. Mood disorders in women. London: Martin Dunitz Ltd, 2000Google Scholar
  53. 53.
    Rowe T, Sasse V. Androgens and premenstrual symptoms — the response to therapy. In: Deneerstein L, Frazer I, editors. Hormones and behaviour. New York (NY): Elsevier Science Publishers, 1986: 160–5Google Scholar
  54. 54.
    Burnet RB, Radden HS, Easterbrook EG, et al. Premenstrual syndrome and spironolactone. Aust NZ J Obstet Gynaecol 1991; 31: 366–8CrossRefGoogle Scholar
  55. 55.
    Dougherty DM, Bjork JM, Moeller FG, et al. The influence of menstrual-cycle phase on the relationship between testosterone and aggression. Physiol Behav 1997; 62: 431–5PubMedCrossRefGoogle Scholar
  56. 56.
    Bäckström T, Aakvaag A. Plasma prolactin and testosterone during the luteal phase in women with premenstrual tension syndrome. Psychoneuroendocrinol 1981; 6: 245–51CrossRefGoogle Scholar
  57. 57.
    Rubinow DR, Hoban MC, Grover GN, et al. Changes in plasma hormones across the menstrual cycle in patients with menstrually related mood disorder and in control subjects. Am J Obstet Gynecol 1988; 158: 5–11PubMedGoogle Scholar
  58. 58.
    Bloch M, Schmidt PJ, Su TP, et al. Pituitary-adrenal hormones and testosterone across the menstrual cycle in women with premenstrual syndrome and controls. Biol Psychiatry 1998; 43: 897–903PubMedCrossRefGoogle Scholar
  59. 59.
    Hammarback S, Bäckström T, Holst J, et al. Cyclical mood changes as in the premenstrual tension syndrome during sequential estrogen-progestagen postmenopausal replacement therapy. Acta Obstet Gynecol Scand 1985; 64: 393–7PubMedCrossRefGoogle Scholar
  60. 60.
    Rapkin AJ, Morgan M, Goldman L, et al. Progesterone metabolite allopregnanolone in women with premenstrual syndrome. Obstet Gynecol 1997; 90: 709–14PubMedCrossRefGoogle Scholar
  61. 61.
    Schmidt PJ, Purdy RH, Moore Jr PH, et al. Circulating levels of anxiolytic steroids in the luteal phase in women with premenstrual syndrome and in control subjects. J Clin Endocrinol Metab 1994; 79: 1256–60PubMedCrossRefGoogle Scholar
  62. 62.
    Wang M, Seippel L, Purdy RH, et al. Relationship between symptom severity and steroid variation in women with premenstrual syndrome: study on serum pregnenolone, pregnenolone sulfate, 5 α-pregnane-3,20-dione and 3 α-hydroxy-5-alpha-pregnan-20-one. J Clin Endocrinol Metab 1996; 81: 1076–82PubMedCrossRefGoogle Scholar
  63. 63.
    Bicikova M, Dibbelt L, Hill M, et al. Allopregnanolone in women with premenstrual syndrome. Horm Metab Res 1998; 30: 227–30PubMedCrossRefGoogle Scholar
  64. 64.
    Muneyvirci-Delale O, Nacharaju VL, Altura BM, et al. Sex steroid hormones modulate serum ionized magnesium and calcium levels throughout the menstrual cycle in women. Fertil Steril 1998; 69: 958–62PubMedCrossRefGoogle Scholar
  65. 65.
    Thys-Jacobs S, Alvir MJ. Calcium-regulating hormones across the menstrual cycle: evidence of a secondary hyperparathyroidism in women with PMS. J Clin Endocrinol Metab 1995; 80: 2227–32PubMedCrossRefGoogle Scholar
  66. 66.
    Korzekwa MI, Lamont JA, Steiner M. Late luteal phase dysphoric disorder and the thyroid axis revisited. J Clin Endocrinol Metab 1996; 81: 2280–4PubMedCrossRefGoogle Scholar
  67. 67.
    Nikolai TF, Mulligan GM, Gribble RK, et al. Thyroid function and treatment inn premenstrual syndrome. J Clin Endocrinol Metab 1990; 70: 1108–12PubMedCrossRefGoogle Scholar
  68. 68.
    Schmidt PJ, Grover GN, Roy-Byrne PP, et al. Thyroid function in women with premenstrual syndrome. J Clin Endocrinol Metab 1993; 76: 671–4PubMedCrossRefGoogle Scholar
  69. 69.
    Girdler SS, Pedersen CA, Straneva PA, et al. Dysregulation of cardiovascular and neuroendocrine responses to stress in premenstrual dysphoric disorder. Psychiatry Res 1998; 81: 163–78PubMedCrossRefGoogle Scholar
  70. 70.
    Woods NF, Lentz MJ, Mitchell ES, et al. Perceived stress, physiologic stress arousal, and premenstrual symptoms: group differences and intra-individual patterns. Res Nurs Health 1998; 21:511–23PubMedCrossRefGoogle Scholar
  71. 71.
    Cahill CA. Differences in Cortisol, a stress hormone, in women with turmoil-type premenstrual symptoms. Nur Res 1998; 47: 278–84CrossRefGoogle Scholar
  72. 72.
    Steiner M, LePage P, Dunn EJ. Serotonin and gender specific psychiatric disorders. Int J Psychiatry Clin Pract 1997; 1:3–13CrossRefGoogle Scholar
  73. 73.
    Rapkin AJ. The role of serotonin in premenstrual syndrome. Clin Obstet Gynecol 1992; 35: 629–36PubMedCrossRefGoogle Scholar
  74. 74.
    Rojansky N, Halbreich U, Zander K, et al. Imipramine receptor binding and serotonin uptake in platelets of women with premenstrual changes. Gynecol Obstet Invest 1991; 31: 146–52PubMedCrossRefGoogle Scholar
  75. 75.
    Steiner M. Female-specific mood disorders. Clin Obstet Gynecol 1992; 35: 599–611PubMedCrossRefGoogle Scholar
  76. 76.
    Yatham LN. Is 5-HT1A receptor subsensitivity a trait marker for late luteal phase dysphoric disorder? Apilot study. Can J Psychiatry 1993; 38: 662–4PubMedGoogle Scholar
  77. 77.
    Wurtman JJ. Depression and weight gain: the serotonin connection. J Affect Disord 1993; 29: 183–92PubMedCrossRefGoogle Scholar
  78. 78.
    Meltzer HY. Serotonergic dysfunction in depression. Br J Psychiatry 1989; 155 Suppl. 8: 25–31Google Scholar
  79. 79.
    Tuiten A, Panhuysen G, Koppeschaar H, et al. Stress, serotonergic function, and mood in users of oral contraceptives. Psychoneuroendocrinology 1995; 20: 323–34PubMedCrossRefGoogle Scholar
  80. 80.
    Cohen IR, Wise PM. Effects of estradiol on the diurnal rhythm of serotonin activity in microdissected brain areas of ovariectomized rats. Endocrinology 1988; 122: 2619–25PubMedCrossRefGoogle Scholar
  81. 81.
    Ladisich W. Influence of progesterone on serotonin metabolism: a possible causal factor for mood changes. Psychoneuroendocrinology 1977; 2: 257–66PubMedCrossRefGoogle Scholar
  82. 82.
    Ashby Jr CR, Carr LA, Cook CL, et al. Alteration of platelet serotonergic mechanisms and monoamine oxidase activity in premenstrual syndrome. Biol Psychiatry 1988; 24: 225–33PubMedCrossRefGoogle Scholar
  83. 83.
    Rapkin AJ, Edelmuth E, Chang LC, et al. Whole blood serotonin in premenstrual syndrome. Obstet Gynecol 1987; 70: 533–7PubMedGoogle Scholar
  84. 84.
    Steege JF, Stout AL, Knight DL, et al. Reduced platelet tritium-labeled imipramine binding sites in women with premenstrual syndrome. Am J Obstet Gynecol 1992; 167: 168–72PubMedGoogle Scholar
  85. 85.
    Taylor DL, Mathew RH, Ho BT, et al. Serotonin levels and platelet uptake during premenstrual tension. Neuropsychobiology 1984; 12: 16–8PubMedCrossRefGoogle Scholar
  86. 86.
    Bancroft J, Cook A, Davidson D, et al. Blunting of neuroendocrine responses to infusion of L-tryptophan in women with perimenstrual mood change. Psychol Med 1991; 21: 305–12PubMedCrossRefGoogle Scholar
  87. 87.
    Bancroft J, Cook A. The neuroendocrine response to d-fenfluramine in women with premenstrual depression. J Affect Disord 1995; 36: 57–64PubMedCrossRefGoogle Scholar
  88. 88.
    Fitzgerald M, Malone K, Li S, et al. Blunted serotonin response to fenfluramine challenge in premenstrual dysphoric disorder. Am J Psychiatry 1997; 154: 556–8PubMedGoogle Scholar
  89. 89.
    Steiner M, Yatham LN, Coote M, et al. Serotonergic dysfunction in women with pure premenstrual dysphoric disorder: is the fenfluramine challenge test still relevant? Psychiatry Res 1999; 87: 107–15PubMedCrossRefGoogle Scholar
  90. 90.
    Su TP, Schmidt PJ, Danaceau M, et al. Effect of menstrual cycle phase on neuroendocrine and behavioral responses to the serotonin agonist m-chlorophenylpiperazine in women with premenstrual syndrome and controls. J Clin Endocrinol Metab 1997; 82: 1220–8PubMedCrossRefGoogle Scholar
  91. 91.
    Menkes DB, Coates DC, Fawcett JP. Acute tryptophan depletion aggravates premenstrual syndrome. J Affect Disord 1994; 32: 37–44PubMedCrossRefGoogle Scholar
  92. 92.
    Steiner M, Judge R, Kumar R. Serotonin re-uptake inhibitors in the treatment of premenstrual dysphoria: current state of knowledge. Int J Psychiatry Clin Pract 1997; 1: 241–7CrossRefGoogle Scholar
  93. 93.
    Halbreich U, Tworek H. Altered serotonergic activity in women with dysphoric premenstrual syndromes. Int J Psychiatry Med 1993; 23: 1–27PubMedCrossRefGoogle Scholar
  94. 94.
    Leibenluft E, Fiero PL, Rubinow DR. Effects of the menstrual cycle on dependent variables in mood disorder research. Arch Gen Psychiatry 1994; 51: 761–81PubMedCrossRefGoogle Scholar
  95. 95.
    Kouri EM, Halbreich U. State and trait abnormalities in women with dysphoric premenstrual syndromes. Psychopharmacol Bull 1997; 33: 767–70PubMedGoogle Scholar
  96. 96.
    Sundstrom I, Andersson A, Nyberg S, et al. Patients with premenstrual syndrome have a different sensitivity to a neuroactive steroid during the menstrual cycle compared to control subjects. Neuroendocrinology 1998; 67: 126–38PubMedCrossRefGoogle Scholar
  97. 97.
    Halbreich U, Petty F, Yonkers K, et al. Low plasma gamma-aminobutyric acid levels during the late luteal phase of women with premenstrual dysphoric disorder. Am J Psychiatry 1996; 153:718–20PubMedGoogle Scholar
  98. 98.
    Gurguis GN, Yonkers KA, Phan SP, et al. Adrenergic receptors in premenstrual dysphoric disorder: I. Platelet α2 receptors: Gi protein coupling, phase of menstrual cycle, and prediction of luteal phase symptom severity. Biol Psychiatry 1998; 44: 600–9PubMedCrossRefGoogle Scholar
  99. 99.
    Mortola JF. Premenstrual syndrome. Trends Endocrinol Metab 1996; 7: 184–9PubMedCrossRefGoogle Scholar
  100. 100.
    Rapkin AJ, Shoupe D, Reading A, et al. Decreased central opioid activity in premenstrual syndrome: luteinizing hormone response to naloxone. J Soc Gynecol Invest 1996; 3: 93–8CrossRefGoogle Scholar
  101. 101.
    Chuong CJ, Coulam CB, Bergstralh EJ, et al. Clinical trial of naltrexone in premenstrual syndrome. Obstet Gynecol 1988; 72: 332PubMedGoogle Scholar
  102. 102.
    Parry BL, Berga SL, Kripke DF, et al. Altered waveform of plasma nocturnal melatonin secretions in premenstrual depression. Arch Gen Psychiatry 1990; 47: 1139–46PubMedCrossRefGoogle Scholar
  103. 103.
    Parry BL, Berga SL, Mostofi N, et al. Plasma melatonin circadian rhythms during the menstrual cycle and after light therapy in premenstrual dysphoric disorder and normal control subjects. J Biol Rhythms 1997; 12(1): 47–64PubMedCrossRefGoogle Scholar
  104. 104.
    Parry BL, Udell C, Elliott JA, et al. Blunted phase-shift responses to morning bright light in premenstrual dysphoric disorder. J Biol Rhythms 1997; 12: 443–56PubMedGoogle Scholar
  105. 105.
    Chuong CJ, Kim SR, Taskin O, et al. Sleep pattern changes in menstrual cycles of women with premenstrual syndrome: a preliminary study. Am J Obstet Gynecol 1997; 177: 554–48PubMedCrossRefGoogle Scholar
  106. 106.
    Nakayama K, Nakagawa T, Hiyama T, et al. Circadian changes in body temperatures during the menstrual cycle of healthy adult females and patients suffering from premenstrual syndrome. Int J Clin Pharmacol Res 1997; 17: 155–64PubMedGoogle Scholar
  107. 107.
    Parry BL, LeVeau B, Mostofi N, et al. Temperature circadian rhythms during the menstrual cycle and sleep deprivation in premenstrual dysphoric disorder and normal comparison subjects. J Biol Rhythms 1997; 12: 34–46PubMedCrossRefGoogle Scholar
  108. 108.
    Kendler KS, Silberg JL, Neale MC, et al. Genetic and environmental factors in the aetiology of menstrual, premenstrual and neurotic symptoms: a population-based twin study. Psychol Med 1992; 22: 85–100PubMedCrossRefGoogle Scholar
  109. 109.
    van den Akker OBA, Stein GS, Neale MC, et al. Genetic and environmental variation in menstrual cycle: histories of two British twin samples. Acta Genet Med Gemellol 1987; 36: 541–8PubMedGoogle Scholar
  110. 110.
    Morse G. Positively refraining perceptions of the menstrual cycle among women with premenstrual syndrome. J Obstet Gynecol Neonatal Nurs 1999; 28: 165–74PubMedCrossRefGoogle Scholar
  111. 111.
    Stotland NL, Harwood B. Social, political, and legal considerations. In: Gold JH, Severino SK, editors. Premenstrual dysphorias: myths and realities. Washington, DC: American Psychiatric Press, 1994: 185–200Google Scholar
  112. 112.
    Marvan ML, Escobedo C. Premenstrual symptomatology: role of prior knowledge about premenstrual syndrome. Psychosom Med 1999; 61: 163–7PubMedGoogle Scholar
  113. 113.
    Fontaine KR, Seal A. Optimism, social support, and premenstrual dysphoria. J Clin Psychol 1997; 53: 243–7PubMedCrossRefGoogle Scholar
  114. 114.
    Seideman RY. Effects of a premenstrual syndrome education program on premenstrual symptomatology. Health Care Women Int 1990; 11: 491–501PubMedCrossRefGoogle Scholar
  115. 115.
    Walton J, Youngkin E. The effect of a support group on self-esteem of women with premenstrual syndrome. J Obstet Gynecol Neonatal Nurs 1987; 16: 174–8PubMedCrossRefGoogle Scholar
  116. 116.
    Kraemer GR, Kraemer RR. Premenstrual syndrome: diagnosis and treatment experiences. J Women’s Health 1998; 7: 893–907CrossRefGoogle Scholar
  117. 117.
    Rubinow DR, Schmidt PJ, Roca CA. Hormone measures in reproductive endocrine-related mood disorders: diagnostic issues. Psychopharmacol Bull 1998; 34: 289–90PubMedGoogle Scholar
  118. 118.
    Reid RL. Premenstrual syndrome. Curr Probl Obstet Gynecol Fert 1985; 8: 1–57Google Scholar
  119. 119.
    Mortola JF, Girton L, Beck L, et al. Diagnosis of premenstrual syndrome by a simple, prospective, and reliable instrument: the calendar of premenstrual experiences. Obstet Gynecol 1990; 76: 302–7PubMedGoogle Scholar
  120. 120.
    Steiner M, Steinberg S, Stewart D, et al. Fluoxetine in the treatment of premenstrual dysphoria. N Engl J Med 1995; 332: 1529–34PubMedCrossRefGoogle Scholar
  121. 121.
    Steiner M, Haskett RF, Carroll BJ. Premenstrual tension syndrome: the development of research diagnostic criteria and new rating scales. Acta Psychiatr Scand 1980; 62: 177–90PubMedCrossRefGoogle Scholar
  122. 122.
    Steiner M, Streiner DL, Steinberg S, et al. The measurement of premenstrual mood symptoms. J Affect Disord 1999; 53:269–73PubMedCrossRefGoogle Scholar
  123. 123.
    Hendrick V, Altshuler LL. Recurrent mood shifts of premenstrual dysphoric disorder can be mistaken for rapid-cycling bipolar II disorder. J Clin Psychiatry 1998; 59: 479–80PubMedCrossRefGoogle Scholar
  124. 124.
    Macmillan I, Young A. Bipolar II disorder vs. premenstrual dysphoric disorder. J Clin Psychiatry 1999; 60: 409–10PubMedCrossRefGoogle Scholar
  125. 125.
    Maskall DD, Lam RW, Misri S, et al. Seasonally of symptoms in women with late luteal phase dysphoric disorder. Am J Psychiatry 1997; 154: 1436–41PubMedGoogle Scholar
  126. 126.
    Steiner M, Yonkers K. Depression in women, mood disorders associated with reproductive cyclicity. London: Martin Dunitz Ltd, 1998: 13–20Google Scholar
  127. 127.
    Brockington I. Menstrual psychosis. Arch Women’s Ment Health 1998; 1: 3–13CrossRefGoogle Scholar
  128. 128.
    Halbreich U. Premenstrual dysphoric disorders: a diversified cluster of vulnerability traits to depression. Acta Psychiatr Scand 1997; 95: 169–76PubMedCrossRefGoogle Scholar
  129. 129.
    Odber J, Cawood EH, Bancroft J. Salivary Cortisol in women with and without perimenstrual mood changes. J Psychosom Res 1998; 45: 557–68PubMedCrossRefGoogle Scholar
  130. 130.
    Facchinetti F, Tarabusi M, Nappi G. Premenstrual syndrome and anxiety disorders: a psychobiological link. Psychother Psychosom 1998; 67: 57–60PubMedCrossRefGoogle Scholar
  131. 131.
    Ekholm UB, Ekholm NO, Bäckström T. Premenstrual syndrome: comparison between different methods to diagnose cyclicity using daily symptom ratings. Acta Obstet Gynecol Scand 1998; 77: 551–7PubMedCrossRefGoogle Scholar
  132. 132.
    Gehlert S, Chang CH, Hartlage S. Establishing the diagnostic validity of premenstrual dysphoric disorder using Rasch analysis. J Outcome Meas 1997; 1:2–18PubMedGoogle Scholar
  133. 133.
    Gehlert S, Chang CH, Hartlage S. Symptom patterns of premenstrual dysphoric disorder as defined in the DSM-IV. J Wornens Health 1999; 8: 75–85CrossRefGoogle Scholar
  134. 134.
    Rapkin AJ, Cedars M, Morgan M. Insulin-like growth factor-1 and insulin-like growth factor-binding protein-3 in women with premenstrual syndrome. Fertil Steril 1998; 70: 1077–80PubMedCrossRefGoogle Scholar
  135. 135.
    Parry BL, Mostofi N, LeVeau B, et al. Sleep EEG studies during early and late partial sleep deprivation in premenstrual dysphoric disorder and normal control subjects. Psychiatry Res 1999; 85: 127–43PubMedCrossRefGoogle Scholar
  136. 136.
    Wyatt KM, Dimmock PW, Jones PW, et al. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ 1999; 318: 1375–81PubMedCrossRefGoogle Scholar
  137. 137.
    Thys-Jacobs S, Starkey P, Bernstein D, et al. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Am J Obstet Gynecol 1998; 179: 444–52PubMedCrossRefGoogle Scholar
  138. 138.
    Walker AF, De Souza MC, Vickers MF, et al. Magnesium supplementation alleviates premenstrual symptoms of fluid retention. J Women’s Health 1998; 7: 1157–65CrossRefGoogle Scholar
  139. 139.
    Parry BL, Mahan AM, Mostofi N, et al. Light therapy of late luteal phasae dysphoric disorder: an extended study. Am J Psychiatry 1993; 150: 1417–9PubMedGoogle Scholar
  140. 140.
    Parry BL. Light therapy of premenstrual depression. In: Lam RW, editor. Seasonal affective disorder and beyond. Washington, DC: American Psychiatric Press, 1998: 173–91Google Scholar
  141. 141.
    Lam RW, Carter D, Misri S, et al. A controlled study of light therapy in women with late luteal phase dysphoric disorder. Psychiatry Res 1999; 86: 185–92PubMedCrossRefGoogle Scholar
  142. 142.
    Blake F, Salkovskis P, Gath D, et al. Cognitive therapy for premenstrual syndrome. J Pyschosom Res 1998; 45: 307–18CrossRefGoogle Scholar
  143. 143.
    Morse CA, Dennerstein L, Farrell E, et al. A comparison of hormone therapy, coping skills training, and relaxation for the relief of premenstrual syndrome. J Behav Med 1991; 14: 469–89PubMedCrossRefGoogle Scholar
  144. 144.
    Pearlstein TB. Nonpharmacologic treatment of premenstrual syndrome. Psychiatr Ann 1996; 26: 590–4Google Scholar
  145. 145.
    Morse GG. Effect of positive refraining and social support on perception of perimenstrual changes among women with premenstrual syndrome. Health Care Women Int 1997; 18: 175–93PubMedCrossRefGoogle Scholar
  146. 146.
    Su T-P, Schmidt PJ, Danaceau MA, et al. Fluoxetine in the treatment of premenstrual dysphoria. Neuropsychopharmacology 1997; 16: 346–56PubMedCrossRefGoogle Scholar
  147. 147.
    Pearlstein TB, Stone AB, Lund SA, et al. Comparison of fluoxetine, bupropion, and placebo in the treatment of premenstrual dysphoric disorder. J Clin Psychopharmacol 1997; 17: 261–6PubMedCrossRefGoogle Scholar
  148. 148.
    Steiner M, Korzekwa M, Lamont J, et al. Intermittent fluoxetine dosing in the treatment of women with premenstrual dysphoria. Psychopharmacol Bull 1997; 33: 771–4PubMedGoogle Scholar
  149. 149.
    Diegoli MS, da Fonseca AM, Diegoli CA, et al. A double-blind trial of four medications to treat severe premenstrual syndrome. Int J Gynaecol Obstet 1998; 62: 63–7PubMedCrossRefGoogle Scholar
  150. 150.
    Yonkers KA, Halbreich U, Freeman E, et al. Symptomatic improvement of premenstrual dysphoric disorder with sertraline treatment. JAMA 1997; 278: 983–8PubMedCrossRefGoogle Scholar
  151. 151.
    Young SA, Hurt PH, Benedek DM, et al. Treatment of premenstrual dysphoric disorder with sertraline during the luteal phase: a randomized, double-blind, placebo-controlled crossover trial. J Clin Psychiatry 1998; 59: 76–80PubMedCrossRefGoogle Scholar
  152. 152.
    Jermaine DM, Preece CK, Sykes RL, et al. Luteal phase sertraline treatment for premenstrual dysphoric disorder. Results of a double-blind, placebo-controlled, crossover study. Arch Fam Med 1999; 8: 328–32CrossRefGoogle Scholar
  153. 153.
    Halbreich U, Smoller JW. Intermittent luteal phase sertraline treatment of dysphoric premenstrual syndrome. J Clin Psychiatry 1997; 58: 399–402PubMedCrossRefGoogle Scholar
  154. 154.
    Freeman EW, Rickels K, Arredondo F, et al. Full- or half-cycle treatment of severe premenstrual syndrome with a serotonergic antidepressant. J Clin Psychopharmacol 1999; 19: 3–8PubMedCrossRefGoogle Scholar
  155. 155.
    Eriksson E, Hedberg MA, Andersch B, et al. The serotonin reuptake inhibitor paroxetine is superior to the noradrenaline reuptake inhibitor maprotiline in the treatment of premenstrual syndrome. Neuropsychopharmacol 1995; 12: 167–76CrossRefGoogle Scholar
  156. 156.
    Sundblad C, Wikander I, Andersch B, et al. A naturalistic study of paroxetine in premenstrual syndrome: efficacy and side-effects during ten cycles of treatment. Eur Neuropsychopharmacol 1997; 7: 201–6PubMedCrossRefGoogle Scholar
  157. 157.
    Wikander I, Sundblad C, Andersch B, et al. Citalopram in premenstrual dysphoria: is intermittent treatment during luteal phases more effective than continuous medication throughout the menstrual cycle? J Clin Psychopharmacol 1998; 18: 390–8PubMedCrossRefGoogle Scholar
  158. 158.
    Sundblad C, Modigh K, Andersch B, et al. Clomipramine effectively reduces premenstrual irritability and dysphoria: a placebo controlled trial. Acta Psychiatr Scand 1992; 85: 39–47PubMedCrossRefGoogle Scholar
  159. 159.
    Sundblad C, Hedberg MA, Eriksson E. Clomipramine administered during the luteal phase reduces the symptoms of premenstrual syndrome: a placebo controlled trial. Neuropsychopharmacol 1993; 9: 133–45Google Scholar
  160. 160.
    Steinberg S, Annable L, Young SN, et al. A placebo-controlled clinical trial of L-tryptophan in premenstrual dysphoria. Biol Psychiatry 1999; 45: 313–20PubMedCrossRefGoogle Scholar
  161. 161.
    Harrison WM, Endicott J, Rabkin JG, et al. Treatment of premenstrual dysphoria with alprazolam and placebo. Psychopharmacol Bull 1987; 23: 150–3PubMedGoogle Scholar
  162. 162.
    Smith S, Rinehart JS, Ruddock VE, et al. Treatment of premenstrual syndrome with alprazolam: results of a double-blind, placebo-controlled, randomized crossover trial. Obstet Gynecol 1987; 70: 37–43PubMedGoogle Scholar
  163. 163.
    Harrison WM, Endicott J, Nee J. Treatment of premenstrual dysphoria with alprazolam. Arch Gen Psychiatry 1990; 47: 270–5PubMedCrossRefGoogle Scholar
  164. 164.
    Berger CP, Presser B. Alprazolam in the treatment of two subsamples of patients with late luteal phase dysphoric disorder: a double-blind, placebo-controlled crossover study. Obstet Gynecol 1994; 84: 379–85PubMedGoogle Scholar
  165. 165.
    Freeman EW, Rickels K, Sondheimer SJ, et al. A double-blind trial of oral progesterone, alprazolam, and placebo in treatment of severe premenstrual syndrome. JAMA 1995; 274: 51–7PubMedCrossRefGoogle Scholar
  166. 166.
    Rickels K, Freeman E, Sondheimer S. Buspirone in treatment of premenstrual syndrome [letter]. Lancet 1989; I: 777CrossRefGoogle Scholar
  167. 167.
    Brown CS, Ling FW, Farmer RG, et al. Buspirone in the treatment of premenstrual syndrome. Drug Ther 1990; 20 Suppl. : 112–21Google Scholar
  168. 168.
    Sarno AP, Miller Jr EJ, Lundblad EG. Premenstrual syndrome: beneficial effects of periodic low-dose danazol. Obstet Gynecol 1987; 70: 33–6PubMedGoogle Scholar
  169. 169.
    Hahn PM, VanVugt DA, Reid RL. A randomized, placebo-controlled crossover trial of danazol for the treatment of premenstrual syndrome. Psychoneuroendocrinology 1995; 20:193–209PubMedCrossRefGoogle Scholar
  170. 170.
    O’Brien PM, Abukhalil IE. Randomized controlled trial of the management of premenstrual syndrome and premenstrual mastalgia using luteal phase-only danazol. Am J Obstet Gynecol 1999; 180 (1 Pt 1): 18–23PubMedCrossRefGoogle Scholar
  171. 171.
    Brown CS, Ling FW, Andersen RN, et al. Efficacy of depot leuprolide in premenstrual syndrome: effect of symptom severity and type in a controlled trial. Obstet Gynecol 1994; 84: 779–86PubMedGoogle Scholar
  172. 172.
    Freeman EW, Sondheimer SJ, Rickels K. Gonadotropin-releasing hormone agonist in the treatment of premenstrual symptoms with and without ongoing dysphoria: a controlled study. Psychopharmacol Bull 1997; 33: 303–9PubMedGoogle Scholar
  173. 173.
    Mezrow G, Shoupe D, Spicer D, et al. Depot leuprolide acetate with estrogen and progestin add-back for long-term treatment of premenstrual syndrome. Fertil Steril 1994; 62: 932–7PubMedGoogle Scholar
  174. 174.
    Hammarback S, Bäckström T. Induced anovulation as treatment of premenstrual tension syndrome. A double-blind cross-over study with GnRH-agonist versus placebo. Acta Obstet Gynaecol Scand 1988; 67: 159–66CrossRefGoogle Scholar
  175. 175.
    Bancroft J, Boyle H, Warner P, et al. The use of an LHRH agonist, buserelin, in the long-term management of premenstrual syndromes. Clin Endocrinol 1987; 27: 171–82CrossRefGoogle Scholar
  176. 176.
    West CP, Hillier H. Ovarian suppression with the gonadotrophin-releasing hormone agonist goserelin (Zoladex) in management of the premenstrual tension syndrome. Hum Reprod 1994; 9: 1058–63PubMedGoogle Scholar
  177. 177.
    Smith RN, Studd JW, Zamblera D, et al. A randomised comparison over 8 months of 100 micrograms and 200 micrograms twice weekly doses of transdermal oestradiol in the treatment of severe premenstrual syndrome. Br J Obstet Gynaecol 1995; 102: 475–84PubMedCrossRefGoogle Scholar
  178. 178.
    Eriksson E. Serotonin reuptake inhibitors for the treatment of premenstrual dysphoria. Int Clin Psychopharmacol 1999; 14 Suppl. 2: S27–S33PubMedGoogle Scholar
  179. 179.
    Freeman EW, Rickels K, Sondheimer SJ, et al. Differential response to antidepressants in women with premenstrual syndrome/premenstrual dysphoric disorder: a randomized controlled trial. Arch Gen Psychiatry 1999; 56: 932–9PubMedCrossRefGoogle Scholar
  180. 180.
    Schmidt PJ, Grover GN, Rubinow DR. Alprazolam in the treatment of premenstrual syndrome. A double-blind, placebo-controlled trial. Arch Gen Psychiatry 1993; 50: 467–73PubMedCrossRefGoogle Scholar
  181. 181.
    Evans SM, Haney M, Levin FR, et al. Mood and performance changes in women with premenstrual dysphoric disorder: acute effects of alprazolam. Neuropsychopharmacology 1998; 19: 499–516PubMedCrossRefGoogle Scholar
  182. 182.
    Evans SM, Foltin RW, Fischman MW. Food ‘cravings’ and the acute effects of alprazolam on food intake in women with premenstrual dysphoric disorder. Appetite 1999; 32: 331–49PubMedCrossRefGoogle Scholar
  183. 183.
    Sundstrom I, Nyberg S, Bixo M, et al. Treatment of premenstrual syndrome with gonadotropin-releasing hormone agonist in a low dose regimen. Acta Obstet Gynecol Scand 1999; 78: 891–9PubMedCrossRefGoogle Scholar
  184. 184.
    Leather AT, Studd JW, Watson NR, et al. The treatment of severe premenstrual syndrome with goserelin with and without ‘add-back’ estrogen therapy: a placebo-controlled study. Gynecol Endocrinol 1999; 13: 48–55PubMedCrossRefGoogle Scholar
  185. 185.
    Watson NR, Studd JW, Savvas M, et al. Treatment of severe premenstrual syndrome with oestradiol patches and cyclical oral norethisterone. Lancet 1989; II: 730–2CrossRefGoogle Scholar
  186. 186.
    Bäckström T, Hansson-Malmstrom Y, Lindhe BA, et al. Oral contraceptives in premenstrual syndrome: a randomized comparison of triphasic and monophasic preparations. Contraception 1992; 46: 253–68PubMedCrossRefGoogle Scholar
  187. 187.
    Graham CA, Sherwin BB. A prospective treatment study of premenstrual symptoms using a triphasic oral contraceptive. J Psychosom Res 1992; 36: 257–66PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonCanada
  2. 2.Women’s Health Concerns ClinicRoom FB639, St Joseph’s HospitalHamiltonCanada
  3. 3.Father Sean O’Sullivan Research CentreSt Joseph’s HospitalHamiltonCanada

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