Premenstrual dysphoric disorder

Many women of reproductive age complain about some premenstrual discomfort. Mood and behavioral symptoms, such as depression or anxiety, and somatic symptoms, such as breast tenderness, may be present. However, only a minority of women meet the criteria for PMDD (premenstrual dysphoric disorder), the most severe form of premenstrual syndrome (PMS), causing substantial distress or functional impairment. The complex pathophysiology of PMDD is not completely understood. As a basis for diagnosis, symptoms should be recorded using prospective daily charting for 2 months. It is mandatory to eliminate other possible diagnoses. Treatment should be tailored according to symptomatology. First-line therapies include serotonin reuptake inhibitors, taken either throughout the whole cycle or during the luteal phase only, and combined hormonal contraceptives with shortened hormone-free intervals or continuously. © 2015, Springer-Verlag Berlin Heidelberg.