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Understanding how to diagnose and treat disorders related to the menstrual cycle is clearly an important issue for clinicians treating women of childbearing age.
As treatment strategies evolve using complimentary alternative medicine or intermittent doses of serotonin-containing antidepressants, it is precisely that worsening of suicide risk which mandates prospective daily symptom ratings (eg, diary) for the diagnosis of premenstrual disorders. This article describes the three major conditions associated with luteal phase symptom changes—premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), and premenstrual exacerbation of an existing disorder (PME). Also common is the brief interjection of symptoms around the time of ovulation, a return to baseline, and then recurrence of symptoms in the late luteal phase.6 Other patterns are less common, and probably represent the premenstrual exacerbation of an underlying mood or anxiety disorder.
Although the ACOG criterion specifically excludes those women, in clinical practice they are often diagnosed and treated like other women with PMS.
Approximately half of these women describe themselves as having premenstrual syndrome and only 3% to 5% meet criteria for premenstrual dysphoric disorder.

If there is no symptom-free interval, the patient is experiencing the premenstrual exacerbation of another disorder, most likely a mood or anxiety disorder.
The PMDD Phenomenon: Breakthrough Treatments for Premenstrual Dysphoric Disorder (PMDD) and Extreme Premenstrual Syndrome (PMS).
Psychophysiological, somatic, and affective changes across the menstrual cycle in women with panic disorder. Vulnerability to perimenstrual mood change: the relevance of a past history of depressive disorder. Premenstrual dysphoric disorder and risk for major depressive disorder: a preliminary study.
Prevalence of premenstrual dysphoric disorder in female patients with seasonal affective disorder.

Effects of menstrual cycle on intake of nicotine, caffeine, and alcohol and nonprescribed drugs in women with late luteal phase dysphoric disorder.
A metabolic basis for fibromyalgia and its related disorders: the possible role of resistance to thyroid hormone. From the standpoint of etiology, however, her symptoms may be more reflective of her menstrual phase than her mood disorder.

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