Sindrome premenstrual

Premenstrual syndrome and premenstrual dysphoric disorder in adolescents
Andrea J. Rapkina and Judith A. Mikacicha,b
Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California and bDepartment of Obstetrics and Gynecology, University of Colorado Denver, Denver, Colorado, USA Correspondence to Andrea J. Rapkin, MD, Department of Obstetrics andGynecology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, CA 90095-1740, USA Tel: +1 310 825 6963; fax: +1 310 206 3670; e-mail: arapkin@mednet.ucla.edu
a

Current Opinion in Obstetrics and Gynecology 2008, 20:455–463

Purpose of review To review the current knowledge about the prevalence, diagnosis, and management of premenstrual syndromes in adolescents. Recentfindings Large epidemiologic studies addressing adolescent premenstrual disorders, clinical presentation, and comorbidity with other disorders have yet to be performed. Randomized controlled treatment trials for teens with moderate-to-severe premenstrual syndrome or the more severe affective predominant, premenstrual dysphoric disorder still are sorely lacking. This review will present an updated reviewof the published studies with respect to premenstrual syndrome and premenstrual dysphoric disorder in adolescents in the context of the large body of literature regarding presentation, diagnosis, and treatment in adult women. Summary Premenstrual disorders likely start in the teen years. At least 20% of adolescents may experience moderate-to-severe premenstrual symptoms associated with functionalimpairment. Current treatment includes lifestyle recommendations and pharmacologic agents that suppress the rise and fall of ovarian steroids or augment serotonin. Keywords adolescents, premenstrual dysphoric disorder, premenstrual syndrome, teens
Curr Opin Obstet Gynecol 20:455–463 ß 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins 1040-872X

Introduction
The research addressingpremenstrual disorders in adolescents is sparse and these disorders may well be underrecognized. Sixty to eighty percent of ovulating women experience some degree of premenstrual symptomatology. However, the diagnosis of premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD) is assigned using specific criteria, to those 20–30% of women whose lives are significantly affected bymoderate-to-severe symptoms. Pharmacologic treatment trials have not generally included adolescents. Treatment in adults has focused on two main approaches: hormonal and psychotropic. Hormonal methods safely eliminate ovarian cyclicity without reinstituting PMS-like physical or emotional symptoms, such as a new low dose combined oral contraceptive (COC) administered in novel dosing regimen. Psychotropicagents augment the neurotransmitter serotonin, and can be administered intermittently in the luteal phase only or continuously. Initial intervention with education, dietary, and lifestyle changes can be effective; however, pharmacologic agents used effectively in adults are recommended for adolescents with moderate-to-severe PMS.
1040-872X ß 2008 Wolters Kluwer Health | Lippincott Williams & WilkinsEpidemiology
Recent studies [1–4] suggest severe PMS affects 12.6– 31% of menstruating women, with prevalence estimates depending on diagnostic criteria utilized. Only 5–8% of women fulfill the strict American Psychiatric Association criteria listed in the Diagnostic and Statistical Manual (DSM) for Mental Disorders for PMDD, but an additional 18% were only one symptom shy of meeting the fiverequisite symptoms for a Diagnostic and Statistical Manual of Mental Disorders – 4th Edition – Text Revision (DSM-IV) PMDD diagnosis [1,5] (Table 1). Retrospectively, adult patients have reported onset of premenstrual symptoms in their teens [6]. Although the peak age of presentation with severe PMS symptoms is in the late 20s, most women state they have been symptomatic for almost 10 years...