Premenstrual dysphoric disorder (PMDD) is characterised by symptoms that occur specifically in the luteal phase of the menstrual cycle and typically resolve shortly after the onset of menstruation. Symptoms manifesting during the menstrual period itself do not align with the diagnostic criteria for PMDD as defined in UK clinical guidelines, which emphasise symptom timing as a key diagnostic feature NICE CKS.
Therefore, if symptoms primarily occur during menstruation rather than before it, this would not be consistent with PMDD but may represent other menstrual or gynecological conditions such as dysmenorrhea or other menstrual-related disorders NICE CKS.
Pharmacological management and psychological interventions for PMDD are targeted at the luteal phase symptoms, with treatments including selective serotonin reuptake inhibitors (SSRIs) and combined oral contraceptives (COCs) that modulate hormonal fluctuations during this phase [1, Altshuler et al. 1995].
In summary, the timing of symptoms is critical: PMDD symptoms must occur before menstruation and improve with its onset; symptoms occurring during menstruation suggest alternative diagnoses and management strategies NICE CKS.