Types of premenstrual syndrome

The International Society for Premenstrual Disorders (ISPMD) has divided premenstrual disorder (PMS) into 2 types. In all premenstrual disorders (PMD), symptoms must be severe enough to affect daily functioning or interfere with work, school performance or interpersonal relationships).

• Core (or typical) PMD
  • most commonly encountered and widely recognised type of PMS
  • symptoms
    • are nonspecific and recur in ovulatory cycles
    • must be present during the luteal phase and abate as menstruation begins, which is then followed by a symptom-free week.
  • there is no limit on the type or number of symptoms experienced; however, some individuals will have predominantly psychological, predominantly somatic or a mixture of symptoms
    • women whose symptoms are predominantly psychological or mixed may also fulfil the criteria for premenstrual dysphoric disorder
• Variant
  • includes more complex features and can be divided into four subtypes
    • ‘premenstrual exacerbation of an underlying disorder’
      • such as diabetes, depression, epilepsy, asthma and migraine
      • these patients will experience symptoms relevant to their disorder throughout the menstrual cycle
    • ‘non-ovulatory PMDs’
      • occur in the presence of ovarian activity without ovulation
      • this is poorly understood due to a lack of evidence, but it is thought that follicular activity of the ovary can instigate symptoms
    • ‘progestogen-induced PMDs’
      • caused by exogenous progestogens present in hormone replacement therapy (HRT) and the combined oral contraceptive (COC) pill
      • this reintroduces symptoms to women who may be particularly sensitive to progestogens
        • although progestogen-only contraceptives may introduce symptoms, as they are noncyclical they are not included within variant PMDs and are considered adverse effects (probably with similar mechanisms) of continuous progestogen therapy
    • ‘PMDs with absent menstruation’
      • include women who still have a functioning ovarian cycle, but for reasons such as hysterectomy, endometrial ablation or the levonorgestrel-releasing intrauterine system (LNG-IUS) they do not menstruate

Premenstrual dysphoric disorder (PMDD) - considered to be a severe form of premenstrual syndrome (2), adopted by the American Psychiatric Association and is not in general use outside the USA (1)

Reference:

1. Management of Premenstrual Syndrome: Green-top Guideline No. 48. BJOG. 2017;124(3):e73-e105.
2. Walsh S, Ismaili E, Naheed B, O’Brien S. Diagnosis, pathophysiology and management of premenstrual syndrome. The Obstetrician &Gynaecologist 2015;17:99–104