A 32-year-old woman with regular 28-day cycles presents with perimenstrual dysphoria, irritability, food cravings, and breast tenderness for 10 days before each period, with complete symptom resolution within 4 days of menstrual onset. There is no history of major depression. The most likely diagnosis and first-line pharmacological treatment are:
- A PMS — first-line treatment is oral combined contraceptive pill (Yasmin/drospirenone + EE)
- B PMDD — first-line treatment is GnRH agonist to suppress ovarian cycles
- C PMDD — first-line treatment is continuous SSRIs (sertraline 50–150 mg/day) or luteal-phase SSRIs ✓
- D PMS — first-line treatment is evening primrose oil and calcium supplementation only
Explanation
This presentation — symptoms lasting >5 days, causing functional impairment, with complete resolution after menses — meets DSM-5 criteria for PMDD (Premenstrual Dysphoric Disorder, requiring prospective daily symptom charting over 2 cycles for confirmation). SSRIs are FDA-approved first-line pharmacotherapy for PMDD and can be given continuously or in luteal-phase-only fashion (day 14 to day 2 of cycle) with equivalent efficacy. The COCP with drospirenone (YAZ) is FDA-approved for PMDD and is a first-line option. GnRH agonists are effective second-line but cause hypoestrogenism and require add-back therapy.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.