Recognizing and Treating Premenstrual Dysphoric Disorder in the Obstetric, Gynecologic, and Primary Care Practices

The author’s aim is to aid primary care physicians and obstetrician-gynecologists in correctly diagnosingand treating premenstrual dysphoric disorder (PMDD). The symptoms fluctuate markedly, buttheir timing is key. PMDD patients experience symptoms only during the luteal phase and will have asymptom-free interval after the menstrual flow and before ovulation. The author discusses self-reportinstruments, which are valuable tools for diagnosis when combined with the ICD-10 criteria for premenstrualsyndrome (PMS) or the DSM-IV criteria for PMDD and the ruling out of medical and psychiatricconditions, such as diabetes, hypothyroidism, major depression, and dysthymia, that causesimilar symptoms. Treatment strategies ranging from nonpharmacologic approaches such as dietarymodification and aerobic exercise to pharmacologic interventions such as antidepressants, anxiolytics,and agents to suppress ovulation are examined.