Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

Menstrual Cycle Disorders for the Generalist 971

Signs & Symptoms

■Most frequent: abdominal bloating, anxiety or tension, breast ten-

derness, crying spells, dysmenorrhea, depression, fatigue, unpro-

voked anger or irritability, difficulty concentrating, thirst and appe-

tite changes, edema

tests

n/a

differential diagnosis

■Established guidelines for diagnosis:

➣Criteria for diagnosis of PMS:=30% increase in severity of symp-

tomsin5dpriortomenses compared with the 5 d after menses

➣American Psychiatric Association criteria for premenstrual dys-

phoric disorder (more severe than PMS):

Symptoms begin last wk of luteal phase, remit after onset of

menses

Diagnosis requires >4 of the following, including 1 of first 4:

Affective lability

Persistent and marked anger or irritability

Anxiety or tension

Depressed mood, feelings of hopelessness

Decreased interest in usual activities

Easy fatigability or marked lack of energy

Subjective sense of difficulty concentrating

Changes in appetite, overeating, food craving

Hypersomnia or insomnia

Feelings of being overwhelmed, out of control

Physical symptoms, such as breast tenderness, headaches,

edema, joint or muscle pain, weight gain

Symptoms interfere with work, usual activities or relation-

ships

Symptoms not exacerbation of another psychiatric disorder

management

What to Do First

■Prospective recording (3 mo) to prove problem recurs in luteal phase,

followed by periods free of symptoms

■Exploration of lifestyle, relationships, and interactions

■Focus on issues producing conflict, lack of control

General Measures

■Intensive involvement of clinician