Should premenstrual syndrome and premenstrual dysphoric disorder coexist in diagnostic manuals?

Dear Editor, In the thought-provoking article “Should premenstrual syndrome and premenstrual dysphoric disorder coexist in diagnostic manuals: Exploring the answer through citation analysis” the authors concluded that “the coexistence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) is redundant.” Respectfully we would like to present a contrary view. PMDD is characterized by a pattern of mood, bodily, or cognitive issues that are present during most menstrual cycles, usually during the luteal phase, in the past year. These symptoms start a few days before the arrival of menses, start to resolve a few days later, and then become minimal or non-existent about a week later. Symptoms usually include mood swings, feeling low, worried, or easily irritable, joint aches, malaise, an increase in appetite or sleep, and difficulty concentrating. PMS, however, is a generic term that encompasses a wide range of symptoms that start days to weeks prior to menses and resolve soon after. During their reproductive years, many women suffer from PMS symptoms but do not consider these symptoms to be upsetting or incapacitating. What distinguishes PMDD from PMS is that the symptoms of PMDD cause more significant distress and impairment in socio-occupational, family, and personal functioning. PMS and PMDD are recognized as two distinct diagnostic entities due to differences in clinical presentation, severity, and impact on the patient’s life and daily routine.[1] PMDD has been described in both the DSM-5 and ICD-11 using a set of criteria consisting of specific symptoms, as mentioned above. PMS does not have such strict criteria and can encompass a broader range of symptoms that may not meet the threshold for PMDD. A systematic review and meta-analysis of Indian studies identified 25 studies (22 reported PMS, and 11 reported PMDD) involving 8,542 subjects. The pooled prevalence of PMS and PMDD were 43% and 8%, respectively. Research suggests that PMDD may have distinct biological mechanisms, including hormonal sensitivity and neurotransmitter dysregulation, which are not as pronounced in PMS.[2,3] The management of PMDD often requires more intensive interventions, such as selective serotonin reuptake inhibitors (SSRIs) or hormonal treatments, which may not be necessary for individuals with PMS. Recognizing PMDD as a separate entity allows for targeted treatment strategies that address the specific needs of affected individuals.[4] Various studies have proven that PMDD has a more significant negative impact on quality of life, relationships, and occupational functioning compared to PMS.[5] In conclusion, these differences underscore the necessity of recognizing PMDD and PMS as separate entities within clinical practice and research, ensuring that individuals receive appropriate diagnosis and treatment tailored to their specific clinical condition. Authors contributions Concept and design of paper: AP, SC. Drafting the article and revising it critically: AP, SC. Final editing and approval of the version to be published: AP, SC, SG. All authors have read and approved the manuscript. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.