PATIENT PRESENTATION/HISTORY
PMDD is an individual experience for each woman.3,4 However, women with PMDD generally present with a history of various psychiatric and somatic symptoms that significantly interfere with their occupational or social functions (to be discussed in the Diagnosis section, page 42).1-4 The reported symptoms occur in predictable patterns that are associated with the menstrual cycle, intensifying around the time of menstruation and resolving immediately after onset of menstruation in most cases.1-4
Many psychiatric and medical conditions may be exacerbated during the luteal phase of the menstrual cycle and thus may mimic the signs and symptoms of PMDD (see Table 1).1,4 Therefore, the pattern and severity of symptoms should always be considered when differentiating PMDD from other underlying conditions.1,2,4,5
It is also important to distinguish PMDD from PMS, a condition with which it is frequently confused. The latter manifests with at least one affective or somatic symptom that is bothersome but not disabling.4,5 An accurate differential diagnosis is important, as the management of these two conditions differs significantly.4,5
ASSESSMENT
PMDD assessment should include thorough history taking, with emphasis on medical, gynecologic, and psychiatric history as well as social and familial history (including PMDD and other psychiatric disorders); and physical examination, including gynecologic and mental status assessment and depression screening using the Patient Health Questionnaire (PHQ-9).2,4,13,14 The physical exam is usually unremarkable.14 The most common physical findings during the luteal phase include mild swelling in the lower extremities and breast tenderness.14 Mental status examination, however, may be abnormal during the late luteal phase—albeit with orientation, memory, thoughts, and perceptions intact.13,14
LABORATORY WORKUP
There is no specific laboratory test for PMDD; rather, testing is aimed at ruling out alternative diagnoses.4,14 Relevant studies may include a complete blood count to exclude anemia, a thyroid function test to exclude thyroid disorders, a blood glucose test to exclude diabetes or hypoglycemia, and a ß hCG test to exclude possible pregnancy.4,14 Hormonal tests (eg, for FSH) may be considered for younger women with irregular cycles or for those younger than 40 with suspected premature menopause.4,14
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