{"id":7921,"date":"2025-10-12T00:01:10","date_gmt":"2025-10-12T08:01:10","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=7921"},"modified":"2025-10-02T12:55:54","modified_gmt":"2025-10-02T20:55:54","slug":"pance-question-of-the-day-period-symptoms","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-period-symptoms","title":{"rendered":"PANCE\u00ae Question of the Day: Period symptoms"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-period-symptoms\/#The_correct_answer_to_todays_PANCE%C2%AE_Question_is%E2%80%A6\" >The correct answer to today&#8217;s PANCE\u00ae Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-period-symptoms\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-period-symptoms\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-period-symptoms\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-period-symptoms\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-period-symptoms\/#References\" >References&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Prepare for the PANCE\u00ae with this challenging clinical scenario involving a 25-year-old woman with intense mood swings and physical symptoms that appear 1\u20132 weeks before menstruation and resolve with onset of bleeding. What&#8217;s the most likely diagnosis?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 25-year-old woman presents to the gynecology office with a year of mood swings, feelings of hopelessness, and anxiety that have negatively affected her personal and professional relationships. She also reports struggling with lethargy, easy fatigability, hypersomnia, and bloating. She has not experienced cold intolerance, weight gain, or dry skin. All these symptoms begin about one to two weeks before her period starts and improve significantly once bleeding begins. The patient takes no medications and reports no alcohol or other recreational substance use. Vital signs are within normal limits. A chaperoned examination is unremarkable. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following is the <em>most likely<\/em> diagnosis?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Premenstrual dysphoric disorder (PMDD)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Premenstrual syndrome (PMS)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Depression<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Hypothyroidism<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Substance misuse<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down to find the answer!&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Everybody loves Osmosis.org\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/kizbJZ9cdLg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_PANCE%C2%AE_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s PANCE\u00ae Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Premenstrual dysphoric disorder (PMDD)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Premenstrual syndrome (PMS)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Although PMS can present with cyclical mood swings, anxiety, and bloating, premenstrual dysphoric disorder (PMDD) is distinguished by affective symptoms that are severe enough to interfere with daily functioning.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Depression<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Depression can have similar symptoms to premenstrual dysphoric disorder (PMDD). However, the symptoms of PMDD are cyclically related to the menstrual cycle and typically resolve with the onset of menses, unlike depression.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Hypothyroidism<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Hypothyroidism can cause lethargy, easy fatigability, and mood swings; however, its symptoms are not cyclical. In addition, other symptoms would be expected, such as cold intolerance, weight gain, and\/or dry skin. Symptoms of premenstrual dysphoric disorder (PMDD), the likely diagnosis, are cyclic and occur during the luteal phase of the menstrual cycle.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Substance misuse<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Patients with substance misuse can present with similar symptoms, such as irritability and fatigue, and it should be ruled out during the workup for premenstrual dysphoric disorder (PMDD). However, this patient reports no alcohol or other recreational substance use, and the cyclical nature of her symptoms makes PMDD the most likely diagnosis.\u00a0<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">\u00a0This patient has <strong>severe cyclical <\/strong>symptoms during the <strong>luteal phase <\/strong>of her menstrual cycle, including mood swings, feelings of hopelessness, anxiety, and interpersonal conflicts that can be disabling. These symptoms, along with lethargy, easy fatigability, hypersomnia, and bloating are consistent with the diagnosis of <strong>premenstrual dysphoric disorder (PMDD)<\/strong>.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">PMDD and <strong>premenstrual syndrome (PMS)<\/strong> share symptoms that <strong>begin during the luteal phase and resolve with the onset of menses<\/strong>. However, PMDD symptoms are predominantly affective, more severe, and sometimes disabling, profoundly affecting daily functioning.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Diagnostic criteria for PMDD, according to the <em>Diagnostic and Statistical Manual of Mental Disorders, 5<sup>th<\/sup> edition (DSM-5)<\/em>, are detailed in the table below.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"1024\" width=\"860\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image_13cb31.png?w=860\" alt=\"\" class=\"wp-image-7923\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image_13cb31.png 904w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image_13cb31.png?resize=252,300 252w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image_13cb31.png?resize=768,914 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/10\/image_13cb31.png?resize=860,1024 860w\" sizes=\"auto, (max-width: 860px) 100vw, 860px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Premenstrual dysphoric disorder (PMDD) is a severe, sometimes disabling condition characterized by symptoms that start during the luteal phase and resolve with the onset of menses. Key features include marked affective lability, irritability, anger, increased interpersonal conflicts, depressed mood, feelings of hopelessness, self-deprecating thoughts, anxiety, tension, or feeling on-edge.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch this Osmosis video:\u00a0<\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Premenstrual_syndrome_(PMS)_and_premenstrual_dysphoric_disorder_(PMDD):_Clinical_sciences\">Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD): Clinical sciences<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>American College of Obstetrics and Gynecologists\u2019 committee on clinical practice guidelines-gynecology. Management of premenstrual disorders: ACOG clinical practice guideline no 7. Obstet Gynecol. 2023;142(6):1516-1533. doi:10.1097\/AOG.0000000000005426<\/li>\n\n\n\n<li>Gray SH. Menstrual disorders. Pediatr Rev. 2013;34(1):6-18. doi:10.1542\/pir.34-1-6<\/li>\n\n\n\n<li>Bhatia SC, Bhatia SK. Diagnosis, and treatment of premenstrual dysphoric disorder. Am Fam Physician. 2002;66(7):1239-1248.<\/li>\n\n\n\n<li>Kliegman, RM, St Geme, JW, Blum, NJ, et al, eds. Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020.\u00a0<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/03\/Blog_Display_Ads_MOBILE3_2023.png?w=700\" alt=\"\" class=\"wp-image-4433\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/03\/Blog_Display_Ads_MOBILE3_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2021\/03\/Blog_Display_Ads_MOBILE3_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>Want more PANCE\u00ae-style practice questions? Try Osmosis by Elsevier today! Access your&nbsp;<a href=\"http:\/\/osmosis.org\/create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/em><\/strong><a href=\"https:\/\/www.osmosis.org\/plans\/rn\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><a href=\"https:\/\/www.osmosis.org\/plans\/rn\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Understand the clinical presentation of premenstrual disorders with an emphasis on PMDD, its symptoms, and how to distinguish it from other medical conditions.<\/p>\n","protected":false},"author":204,"featured_media":8089,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[20,38,1371,37,1366],"tags":[176,1611,1610,1608,1123,1609,1606,1607,1605,242],"class_list":["post-7921","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-exam-prep","category-pance","category-pance-questions","category-pa","category-questions","tag-anxiety","tag-clinical-presentation","tag-depression","tag-diagnostic-criteria","tag-menstrual-health","tag-mood-disorders","tag-pmdd","tag-pms","tag-premenstrual-disorders","tag-womens-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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