Premenstrual disphoric disorder: an update

Sindrome disforica premestruale: un aggiornamento

S. Banti1, C. Borri1, M.S. Montagnani1, C. Cargioli1, S. Belli1, B. Cotugno1, J. Endicott2, A. Oppo1, M. Mauri1

1 Clinica Psichiatrica, DPNFB, Università di Pisa, Italy; 2 Dipartimento di Psichiatria, Istituto dei Medici e Chirurghi dell’Università di Columbia, New York, USA


The vast majority of menstruating women experience uncomfortable symptoms during the premenstrual phase, in the luteal phase of their menses. Although many women do not require specific treatment of symptoms, approximately 20- 40% report moderate to severe premenstrual symptoms, and about 3-9% meet diagnostic criteria for premenstrual dysphoric disorder (DDPM), the most severe manifestation of premenstrual symptoms.

Objective and Methods

We searched MEDLINE for all publications on premenstrual syndrome or DDPM. Databases were searched for clinical trials, meta-analyses, practice guidelines and reviews, up to July 2011, using the key words premenstrual dysphoric disorder and premenstrual syndrome combined with the terms diagnosis, epidemiology, aetiology, hormones, serotonin, treatment and antidepressants. Moreover, we searched reference lists from relevant publications to find additional articles.


While the aetiology of premenstrual symptoms remains unclear, several theories have implicated sex steroids and neurotransmitters in their development and manifestation. DDPM has multiple determinants in the biological, psychological and socio-cultural domains; during menstruation it remits and disappears for up to one week from its termination (follicular phase). Developing successful interventions for premenstrual symptoms has been challenging, with interventions focused on a particular aspect of premenstrual symptomatology. Treatments for premenstrual symptoms include lifestyle changes, cognitive-behavioural therapies, supplementation agents and drugs including ovulation suppression regimens, antidepressant medications and anxiolytics.


The current literature on this topic is still scarce. For this reason, further studies are necessary to better define the epidemiology, aetiopathogenesis and treatment of DDPM.

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