Content area
Full Text
Dr. Leahy is Family Psychiatric Advanced Practice Nurse and Master Clinician in Psychopharmacology, APNSolutions, LLC, Sewell, New Jersey.
The author has disclosed no potential conflicts of interest, financial or otherwise.
Exploring psychotherapeutic issues and agents in clinical practice
With the average female experiencing menarche close to the age of 12 and menopause around the age of 52, premenstrual symptoms, occurring just 1 week per month, can disrupt a woman's quality of life for 10 years over the course of the reproductive lifecycle. Treating women with comorbid psychiatric illness and premenstrual exacerbations presents a unique challenge to the prescribing practitioner. The hormonal fluctuations during a woman's menstrual cycle alone can contribute to symptoms of anxiety, depressed mood, anger, irritability, fatigue, sleep disruption, lack of focus, social withdrawal, food cravings, and a host of physical complaints. During the week or two prior to menstrual onset, women diagnosed with a psychiatric illness may also experience a worsening of their condition, even if stabilized on medications. As the symptoms of premenstrual exacerbation mimic those of various psychiatric illnesses, it can be difficult for practitioners to differentiate the root cause of the symptom presentation. For this reason, it is important for practitioners treating women with psychiatric illness to thoroughly explore abrupt symptom changes and their timing in relation to a woman's menses ( Leahy, 2016 ).
What Is Premenstrual Exacerbation?
Various terms are used to describe the constellation of physical and emotional symptoms experienced by women prior to their menses. Stoppler ( 2014 ) defines premenstrual syndrome (PMS) as a complex health concern consisting of various physical, mental, and behavioral symptoms occurring during the 2 weeks prior to the onset of a woman's period and resolving within the first 2 days of menstrual flow. The American College of Obstetricians and Gynecologists ( ACOG; 2000 ) offers diagnostic criteria for PMS, which can be found in Table 1 . Htay, Ahmed, and Aung ( 2016 ) define premenstrual dysphoric disorder (PMDD) as the deterioration of functioning, characterized by depressed or labile mood, anxiety, irritability, anger, and other symptoms causing serious distress and occurring during the 2 weeks prior to the onset of menses and subsiding shortly thereafter. The American Psychiatric Association ( APA; 2013 ) offers diagnostic criteria for PMDD in...