Diagnosis and Management of Premenstrual Dysphoric Disorder, Premenstrual Syndrome, and Premenstrual Exacerbation.

Premenstrual symptoms occur in the late luteal phase as a result of differential sensitivity to normal hormonal fluctuations. These symptoms can include mood symptoms such as mood lability, anxiety, sadness or irritability as well as physical symptoms such as lethargy, bloating and breast tenderness. Symptoms can significantly impact quality of life, particularly in patients with the more severe form of premenstrual symptoms, PMDD. Importantly, symptoms should improve or resolve in the follicular phase. Evidence-based treatment options include SSRIs or hormonal suppression of ovulation with COCs or GnRH agonists.