摘要：

Five percent of menstruating women have severe premenstrual symptoms and impairment of functioning defined as premenstrual dysphoric disorder (PMDD). Clinically significant premenstrual symptoms occur in at least an additional 20% of menstruating women. The diagnosis of PMDD should be confirmed by prospective symptom charting over 2 menstrual cycles to confirm the timing of the symptoms and to rule out other diagnoses. The burden of illness of PMDD includes disruption of parenting and partner relationships and decreased productivity in work roles. In addition, women with PMDD have increased use of health care services such as clinician visits and increased use of prescription medications and over-the-counter preparations. The etiology of PMDD is multifactorial. In particular, dysregulation of the serotonin and allopregnanolone systems is implicated. Several effective treatment options exist, including serotonergic antidepressant medications and an oral contraceptive that contains ethinyl estradiol and drosperinone. In addition, other hormones that suppress ovulation, anxiolytics, cognitive therapy, chasteberry and calcium may be helpful. Cinq pour cent des femmes menstruees ont des symptocaretmes premenstruels severes et une incapacite du fonctionnement appelee trouble dysphorique premenstruel (TDPM). Au moins 20 % de femmes menstruees de plus ont des symptocaretmes premenstruels cliniquement significatifs. Il faut confirmer le diagnostic de TDPM en suivant les symptocaretmes de fac,on prospective au cours de deux cycles menstruels afin de confirmer le moment de l'apparition des symptocaretmes et d'exclure d'autres diagnostics. Le fardeau morbide impose par le TDPM comprend la perturbation des relations avec les enfants et le partenaire et une baisse de productivite au travail. Les femmes atteintes de TDPM ont en outre recours davantage aux services de sante comme les visites aux cliniciens et prennent davantage de medicaments d'ordonnance et en vente libre. L'etiologie du TDPM est multifactorielle. La dysregulation des systemes de la serotonine et de l'allopregnanolone en particulier est mise en cause. Il existe plus d'un traitement efficace possible, y compris des antidepresseurs serotoninergiques et un contraceptif oral qui contient de l'ethinyloestradiol et de la drosperinone. D'autres hormones qui bloquent l'ovulation, des anxiolytiques, la therapie cognitive, le gattilier (Vitex agnus castus) et le calcium peuvent en outre aider. Diagnosis About 80% of women report at least mild premenstrual symptoms, 20%-50% report moderate-to-severe premenstrual symptoms, and about 5% report severe symptoms for several days with impairment of functioning. (1) The 5% of women with the severest premenstrual symptoms and impairment of social and role functioning often meet the diagnostic criteria for premenstrual dysphoric disorder (PMDD). The diagnostic criteria for PMDD are listed in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR), (1) and women who meet criteria for PMDD receive a DSM-IV-TR diagnosis code 311 (i.e., depressive disorder not otherwise specified). To meet the PMDD criteria, at least 5 of 11 possible symptoms must be present in the premenstrual phase, these symptoms should be absent shortly after the onset of menses, and at least 1 of the 5 symptoms must be depressed mood, anxiety, affective lability or irritability. Other symptoms include decreased interest in...

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