It is estimated that up to 80% of women experience some degree of premenstrual symptoms, with approximately 5%-10% of women meeting the criteria for PMS and 2%-3% meeting the criteria for the more severe version called premenstrual dysphoric disorder (PMDD).
Diagnostic criteria for PMS include having at least one symptom of depression, anger outbursts, irritability, anxiety, social withdrawal, and confusion and one symptom of breast tenderness or swelling, abdominal bloating, headache, weight gain, joint or muscle pain, and extremity swelling. These symptoms must occur for at least 3 consecutive menstrual cycles within 5 days of the onset of menses and resolve within 4 days after the onset of menses.
The etiology of PMS is unknown. It has been thought it could be related to fluctuations in hormones, but often testing reveals normal hormone levels in these patients. Despite this, patients often have symptom improvement or resolution with menopause or with hormonal suppression.
N94.3 – Premenstrual tension syndrome
82639001 – Premenstrual tension syndrome
Differential Diagnosis & Pitfalls
- Mood disorders – depression, anxiety, dysthymia
- Substance abuse – alcohol use disorder, benzodiazepine use disorder, cannabis use disorder, cocaine use disorder, methamphetamine use disorder, opioid use disorder
- Thyroid disorders (see hyperthyroidism)
- Perimenopause (see menopause)
- Anemia (see iron deficiency anemia)