Premenstrual Dysphoric Disorder Prevalence and Symptoms across Age Groups: A Cross-Sectional Study
Premenstrual symptoms can manifest at any point after menarche and considerably affect women's quality of life, mental health and personal and work relationships, especially in severe cases. Premenstrual symptoms can be divided into somatic and psychological components. Somatic symptoms include abdominal pain, cramps, nausea, breast pain and swelling, whereas psychological symptoms are further divided into affective (e.g., irritability, anxiety, depressive mood), cognitive (e.g., difficulty in concentrating, memory loss), neurovegetative (e.g., low libido, insomnia, hypersomnia, fatigue, lack of energy, increased appetite) and behavioural (e.g., withdrawal from daily activities) symptoms. These symptoms have a clear temporalrelationship with the premenstrual period and cause significant distress that interferes with functionality. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders classifies premenstrual symptoms as depressive disorders under the name “premenstrual dysphoric disorder” (PMDD). There must be a minimum of five symptoms, one of which is a core symptom: affective lability, irritability, depressed mood and anxiety. The term “premenstrual syndrome” (PMS) is applicable to cases in which there are insufficient symptoms of PMDD, which usually occur with less severity.
The present study primarily aimed to estimate the prevalence of PMDD based on self-reported somatic and psychoemotional symptoms. Its secondary objectives were to estimate the prevalence and severity of each premenstrual symptom by age and to conduct an association analysis between psychoemotional and somatic symptoms. This is a secondary analysis from a previous study that evaluated the prevalence, intensity and regional distribution of PMS in the same population. This study will improve knowledge and awareness of a disorder that significantly impacts the quality of life of women of reproductive age.
To estimate the prevalence and symptom severity of premenstrual dysphoric disorder (PMDD) in Brazilian women according to age groups, and to conduct an association analysis between psychoemotional and somatic symptoms.
Prevalence of PMDD was 3.57% (95% CI: 3.40–3.75). Psychoemotional symptoms were more prevalent than somatic symptoms, with anxiety/tension (99.9%) and irritability/anger (99.8%) being the most frequently reported symptoms. Weight gain (92.5%) and edema (92.1%) were the most prevalent somatic symptoms. Anxiety/tension and headache occurred independently of other symptoms. Binge eating was associated with weight gain (OR=2.77, 95% CI [2.11, 3.62]), acne (OR=2.37, 95% CI [1.79, 3.10]), immunoallergic exacerbations (OR=1.81, 95% CI [1.26, 2;60]) and edema (OR—0.74, 95% CI [0.55, 0.97]). Affective lability was associated with immunoallergic exacerbations (OR=1.49, 95% CI [1.16, 1.91]) and mastalgia (OR=1.29, 95% CI [1.02, 1.63]). Depression was associated with acne (OR=0.72, 95% CI [0.57, 0.89]) and weight gain (OR=0.77, 95% CI [0.61, 0.96]).
The prevalence of PMDD found in this study is consistent with that reported by other investigations, in which the percentages varied from 1.8% to 5.8%, including Brazilian studies. This result is similar to the pooled prevalence of confirmed diagnosis found in the largest and most recent systematic review on the prevalence of PMDD. The high prevalence of psychoemotional symptoms is also consistent with the findings of other studies. A previous study based on the same population found that 38.91% met criteria for PMS. Although affective lability and depression/sadness are core symptoms, they were not among the four most common severe symptoms. Depression/sadness ranked as the fifth most prevalent symptom, behind decreased interest in routine activities. Affective lability was the eighth most prevalent severe symptom, behind weight gain and headache.
Authors expected to observe fewer symptoms in the 40–49-year-old group because severe symptoms have been reported by epidemiological studies to be more prevalent in younger women. No statistically significant difference was found among the age groups with respect to the total number of severe symptoms. Additionally, the number of moderate and severe psychoemotional symptoms did not significantly differ, however our analysis showed that somatic symptoms were less prevalent in the younger age group.
Symptoms such as depression and anxiety may worsen during the menopausal transition in women with PMS or with more symptomatic menstruation during early life. In this study, the only symptoms that were more prevalent in the 40–49-year-old group were anxiety/ tension and affective lability. Regarding treatment, more women in the 20–29-year age group were willing to use contraceptives as treatment for premenstrual symptoms. This age group could benefit from contraception when necessary; if this is the chosen method, these medications would be worth considering. The slightly higher resistance to contraceptive use as treatment for PMDD may have arisen from the misconception that these medications can only be used for birth control or that hormonal treatments may pose a greater risk. Older patients may benefit from educational programs on contraceptive knowledge.
An understanding of the epidemiology of PMDD in this sample of Brazilian women and the symptomatic profiles in different age groups can guide the development of more effective and specific diagnostic and treatment protocols for each population. Because menstrual disorders have characteristics that fit into two major specialties (namely, psychiatry and gynaecology), they do not often receive due attention from health professionals, resulting in incomplete investigations or ineffective treatment. For a psychiatrist's clinical practice, knowing and investigating the patterns of symptom changes during the menstrual period, which are routinely performed by a gynaecologist, can help differentiate the aetiology of these symptoms in patients, possibly resulting in different therapeutic proposals. Gynaecologists may benefit from a better knowledge of therapeutic measures for these disorders, such as the use of antidepressants and nonpharmacological therapeutic techniques. Although no evidence supports the superiority of a specific drug type, there are differences in side-effect profiles between selective serotonin reuptake inhibitor antidepressants and oral contraceptives, which are both considered the first-line treatments. By understanding the most prevalent symptoms and treatment expectations of women, the most appropriate treatment can be selected. This reduces the time required to achieve the desired response and minimises the impact of illness on their lives.
Source: Adriana Orcesi Pedro, Roberto Carmignani Verdade, Maura Gonzaga Lapa; BJOG: An International Journal of Obstetrics & Gynaecology, 2025; 0:1–10 https://doi.org/10.1111/1471-0528.18261
