Emily is a 35-year-old woman who presents to a mental health clinic with complaints of significant mood swings and irritability that coincide with her menstrual cycle. She reports feeling intensely sad and hopeless during the week before her period, followed by a sudden improvement in mood once her period begins. Emily also experiences physical symptoms such as fatigue, bloating, and breast tenderness during this time. She has a history of depression and anxiety, but her symptoms have worsened in recent months.