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Women with a severe form of premenstrual syndrome (PMS) experience their peak symptoms both before and up to three days after they begin menstruation, a new study says.
The findings run counter to the traditional view that the condition, called premenstrual dysphoric disorder, or PMDD, strikes most prominently before menstruation, and that the symptoms, including severe mood swings and anxiety, begin to wane with the start of a woman's period.
The results mean doctors should consider the time both before and after menstruation when they diagnose PMDD, the researchers said.
The findings may also affect how the condition is described in the newest version of the Diagnostic and Statistical Manual of Mental Disorders, which details symptoms of and treatments for mental health conditions, and is scheduled for publication in 2013, the researchers said.
Many women experience physical symptoms around the time menstruation, and about 30 percent have cases severe enough to be diagnosed with PMS, but only about 3 to 8 percent have PMDD, according to the National Institutes of Health.
The researchers surveyed 193 women living in the Chicago area who had been diagnosed with PMDD or severe PMS, and 864 women who had not. The participants recorded their symptoms throughout two menstrual cycles, noting their severity and how much they interfered with daily life.
The results showed that for women without the condition, symptoms most often began three days before the start of menstruation and continued for six days, whereas for women with PMDD, symptoms began four days before menstruation, and continued six days. Mood swings and physical symptoms such as bloating were among the most severe symptoms reported.
The researchers also suggested that women need to have four symptoms to be diagnosed with premenstrual dysphoric disorder, but said the question needs further study. The current edition of the Diagnostic and Statistical Manual of Mental Disorders requires five symptoms to be present for a diagnosis.
Unless the description is changed, "many women may not be diagnosed as having PMDD," even if they have the condition, the researchers write in the March issue of the journal Archives of General Psychiatry.
Pass it on: Peak symptoms of PMDD may occur both before and a few days after menstruation begins.