A 28-year-old female graduate student presents to your nurse practitioner clinic stating, “I feel like I’m losing my mind every month before my period.” For the last two years, she has experienced profound irritability, mood swings, anxiety, and feelings of hopelessness, which begin about one week before her menses. The symptoms are severe enough that she has frequent arguments with her partner and has difficulty concentrating on her dissertation. She also notes significant fatigue, breast tenderness, and bloating. She reports that these symptoms completely resolve within two to three days after her period starts, and she feels “perfectly normal” for the rest of the month. She denies any history of depression or anxiety outside of this pattern. She has tried over-the-counter analgesics for physical discomfort without any effect on her mood symptoms. She denies suicidal ideation. Her menstrual cycles are regular, occurring every 28-30 days. She is in a stable, monogamous relationship and uses barrier contraception. Her past medical, surgical, and family histories are non-contributory. She drinks alcohol socially (1-2 drinks per week) and denies tobacco or illicit drug use.