Premenstrual dysphoric disorder: evaluation, pathophysiology and treatment.

A small percentage of women describe a prominent dysphoric disturbance that is present during the premenstrual week, remits soon after the onset of menses and produces significant impairment in domestic, social or occupational functioning. Premenstrual dysphoric disorder must be distinguished from minor premenstrual emotional changes, from dysmenorrhea and from premenstrual exacerbations of psychiatric illness. Diagnostic evaluation should include the prospective assessment of symptoms over at least two complete menstrual cycles. Although the pathophysiology of premenstrual dysphoric disorder is linked to cycling of the intact hypothalamo-pituitary-gonadal axis, many studies have contained serious methodological weaknesses and no single etiological theory has received widespread support. No single pharmacological treatment has been shown to be clearly more effective than placebo in controlled studies and premenstrual dysphoric disorder appears to respond favorably to most interventions in uncontrolled studies. Interruption of pituitary-ovarian cycling will alleviate premenstrual symptoms, but treatments of this type cannot be recommended for general use until potential hazards are clarified.