Premenstrual syndromes.

Premenstrual syndrome research has made a great deal of progress since 1983 when the criteria for the diagnosis were clearly defined. Confirming the diagnosis prospectively and ruling out other disorders was a major methodologic advance. The DSM-IV criteria for PMDD now help us identify and classify women who have severe psychologic symptoms during the premenstruum. Although we do not have a definitive cause for PMDD, the consensus is that it is the end result of a complex series of events mediated partly by the serotonin system and triggered by ovulation. Women who meet criteria for PMS, do not meet the criteria for PMDD, and do not have a concurrent disorder should be treated conservatively. Women who meet criteria for PMDD can be treated successfully with low-dose clomipramine, SSRIs, or GnRH-as with "add back" estrogen and progestins.