Gaining Insight into the Experiences of Women with Premenstrual Dysphoric Disorder and Improving Outcomes

Premenstrual symptoms have the potential to impact all women of reproductive age. Roughly 70-90% of women experience some level of premenstrual discomfort, while 3-8% experience the most severe, complex form, PMDD (Mishra, Elliot, and Marwaha, 2022). PMDD symptomatology is complex, and therefore overlaps with other diagnoses, which has complicated the diagnostic process. There is a growing body of evidence to support that PMDD has been misdiagnosed or disregarded, and stigmatized by providers, and improvements are needed in both the education about the diagnostic process, as well as the diagnostic process itself. The purpose of this quality improvement project was to improve the quality of the assessment, diagnosis, and management of PMDD, and gain insight into the lived experiences from those living with the disorder as well as insight into the management of the disorder from clinicians. The populations of interest were menstruating females, age 18-45, documented history of mood instability or mood changes, in addition to treating clinicians at an outpatient psychiatric clinic. Practice changes that were implemented were as follows: implementation of the premenstrual symptoms screening tool (Appendix A) within the medical record; creation and distribution of informative/educational pamphlet/PDF for clinicians about PMDD diagnosis, assessment and treatment (Appendix B); creation and distribution of likert and open ended survey to measure perception of patients regarding diagnostic process, treatment and care overall; creation and distribution of likert and open ended survey to measure perception of clinicians regarding the use of the tool and how it affected their clinical decision making. Outcomes focused on screening practices and results, documentation in the medical record, engagement, and patient perception. Data was analyzed using clinical record reviews, interviews, Likert-type scales, and coding. Descriptive statistics were used to describe the population, and pre/post intervention changes. Relevant insight was gained on the knowledge gap and under recognition of Women's Health disorders such as PMDD and on screening practices. The project was successful in improving knowledge base of PMDD in both patients and clinicians. The limitations focused on patients’ engagement in the survey on follow up, as well as clinician engagement in the project overall. To further improve the diagnostic process, increase education and reduce stigma, future research may focus on improving engagement of clinicians and patients, and/or assessing current screening practices or treatment regimens for PMDD.