Premenstrual disorders

  • Kimberly Ann Yonkers
    Corresponding author: Kimberly Ann Yonkers, MD.
    Department of Psychiatry, Yale University School of Medicine, New Haven, CT

    Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT

    Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT
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  • Michael K. Simoni
    Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
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      Premenstrual disorders include premenstrual syndrome, premenstrual dysphoric disorder, and premenstrual worsening of another medical condition. While the underlying causes of these conditions continue to be explored, an aberrant response to hormonal fluctuations that occurs with the natural menstrual cycle and serotonin deficits have both been implicated. A careful medical history and daily symptom monitoring across 2 menstrual cycles is important in establishing a diagnosis. Many treatments have been evaluated for the management of premenstrual disorders. The most efficacious treatments for premenstrual syndrome and premenstrual dysphoric disorder include serotonin reuptake inhibitors and contraceptives with shortened to no hormone-free interval. Women who do not respond to these and other interventions may benefit from gonadotropin-releasing hormone agonist treatment.

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      Linked Article

      • Evidence-Based Treatments for Premenstrual Disorders
        American Journal of Obstetrics & GynecologyVol. 219Issue 2
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          We appreciate Dr Studd and colleagues’ interest in our review but respectfully disagree with their conceptualization of our article.1 We did not express an opinion as to whether premenstrual disorders are endocrine conditions. Clearly, gonadal steroids play a role because symptoms are not present after menopause or during pregnancy. However, premenstrual syndromes, unlike many endocrine disorders, are not associated with a particular brain or noncentral nervous system structure (such as a pituitary adenoma hyperactive thyroid), nor do we see aberrant hormonal levels.
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      • Premenstrual disorders
        American Journal of Obstetrics & GynecologyVol. 219Issue 2
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          The review of the treatment of severe premenstrual syndrome (PMS; premenstrual dysphoric disorder) by Yonkers and Simoni1 is instructive because it reveals the inability of psychiatrists to recognize that severe PMS is essentially an endocrine, not a psychiatric, disorder. The name, premenstrual dysphoric disorder, preferred by the American Psychiatric Association containing the word dysphoric clearly demonstrates their belief that this is a mental health issue and should be treated accordingly.
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