Assessing Premenstrual Dysphoric Disorder

Approximately 5% of all women meet the diagnostic criteria for premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS). PMDD is associated with psychological and somatic symptoms such as depression and anxiety as well as functional impairment.

PMDD typically occurs immediately prior to the onset of the menstrual period and ends two to three days after the monthly menses stop. Clinicians can assess patients with PMDD by evaluating both hormone levels and lifestyle triggers. Hormones can be assessed through month-long salivary tests or urine tests. Lifestyle triggers can be evaluated by asking patients what is going on around them that may cue symptoms.

Monique Class, MS, APRN, BC, IFMCP, educator for the Institute for Functional Medicine, notes that the hormone shift during the luteal phase of the menstrual cycle can create a tipping point that affects a patient’s ability to handle the load of life changes. She suggests clinicians must look at the issue from all dimensions to determine treatment methods that will rebalance the distribution of hormones.