Differential diagnosis

1. PMDD should be differentiated from premenstrual exacerbation of an underlying major psychiatric disorder, as well as medical conditions such as hyper- or hypothyroidism.

2. About 13 percent of women with PMS are found to have a psychiatric disorder alone with no evidence of PMS, while 38 percent had premenstrual exacerbation of underlying depressive and anxiety disorders.

3. 39 percent of women with PMDD meet criteria for mood or anxiety disorders.

4. The assessment of patients with possible PMS or PMDD should begin with the history, physical examination, chemistry profile, complete blood count, and serum TSH. The history should focus in particular on the regularity of menstrual cycles. Appropriate gynecologic endocrine evaluation should be performed if the cycles are irregular (lengths less than 25 or greater than 36 days).

5. The patient should be asked to record symptoms prospectively for two months. If the patient fails to demonstrate a symptom free interval in the follicular phase, she should be evaluated for a mood or anxiety disorder.

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