Premenstrual Syndrome
Premenstrual Syndrome
Premenstrual Syndrome
12180 2015;17:99–104
The Obstetrician & Gynaecologist
Review
http://onlinetog.org
Key content How to treat PMS, including the different treatment options
An overview of current information available on premenstrual available and discussion about side effects and benefits.
syndrome (PMS), which is in accordance with the new RCOG
Ethical issues
Green-top Guideline.
Definition of PMS and explanation about the different types of
Discussion about the long-term risks of GnRH analogue use, and
the impact of long-term estrogen deficiency following a
premenstrual disorders.
How to accurately diagnose PMS.
bilateral salpingoophorectomy.
Misdiagnosed PMS in patients with underlying psychiatric and
Discussion about various treatment options available in
medical conditions.
accordance with the current literature.
Keywords: epidemiology / gynaecology / HRT regimens /
Learning objectives
menopause / pathology / psychiatry
Develop an understanding of the pathophysiology behind PMS.
How to diagnose PMS accurately and understand the different
classifications of PMS.
Please cite this paper as: Walsh S, Ismaili E, Naheed B, O’Brien S. Diagnosis, pathophysiology and management of premenstrual syndrome. The Obstetrician &
Gynaecologist 2015;17:99–104.
Figure 1. Symptom view and diagnosis of woman with typical (core) premenstrual disorder generated by the PreMentricS App (Permission
Granted by PMS O’Brien).
estrogen replacement post-surgery can be unopposed 4 Pearlstein T, Yonkers KA, Fayyad R, Gillespie JA. Pretreatment pattern of
symptom expression in premenstrual dysphoric disorder. J Affect Disord
without the risk of endometrial hyperplasia, and thus 2005;85:275–82.
prevent the PMS side effects associated with progestogens. 5 O’Brien S, Rapkin A, Dennerstein L, Nevatte T. Diagnosis and management
Success rates of hysterectomy with BSO are high and long- of premenstrual disorders. BMJ 2011;342:d2994.
6 Kadian S, O’Brien S. Classification of premenstrual disorders as proposed by
lasting, and now surgical intervention can usually be the International Society for Premenstrual Disorders. Menopause Int
performed laparoscopically, it is less invasive than 2012;18:43–7.
previously.38,39 It is important to remember that all surgical 7 Rapkin AJ, Kuo J. Neurotransmitter physiology: the basics for understanding
premenstrual syndrome. In: O’Brien PMS, Rapkin A, Schmidt P, editors. The
procedures carry an anaesthetic risk, as well as the risk of Premenstrual Syndromes: PMS and PMDD. London: Informa Healthcare;
surgical complications. Surgery undertaken for a mood 2007. p. 69–71.
disorder is unique to PMS management. 8 Pearlstein T, Yonkers KA, Fayyad R, Gillespie JA. Pretreatment pattern of
symptom expression in premenstrual dsyphoric disorder. J Affect Disord
Surgery will render the woman infertile and induces the 2005;85:275–82.
menopause. Estrogen replacement therapy should be 9 Spinelli MG. Depression and hormone therapy. Clin Obstet Gynecol
commenced post-surgery to prevent the effects of 2004;47:428–36.
10 Hunter MS, Ussher JM, Cariss M, Browne S, Jelley R, Katz M. Medical
long-term estrogen deficiency, and should be continued (fluoxetine) and psychological (cognitive-behavioural therapy) treatment for
until the age when menopause naturally occurs.12 premenstrual dysphoric disorder. a study of treatment processes. J
Importantly of course is the absence of endometrium, the Psychosom Res 2002;53:811–7.
11 Endicott J, Nee J, Harrison W. Daily Record of Severity of Problems (DRSP):
estrogen can be administered without the requirement for reliability and validity. Arch Womens Ment Health. 2006;9:41–9.
protective progestogen 12 Borenstein JE, Dean BB, Yonkers KA. Endicott. Using the daily record of
severity of problems as a screening instrument for premenstrual syndrome.
Obstet Gynecol 2007;109:1068–75.
Ongoing assessment 13 Nevatte T, O’Brien PMS, B€ackstr€ om T, Brown C, Dennerstein L, Endicott J,
et al. ISPMD consensus on the management of premenstrual disorders.
It is important to remember that if a woman has not Arch Womens Ment Health 2013;16:279–91.
14 Perkonigg A, Yonkers KA, Pfister H, Lieb R, Wittchen HU. Risk factors for
responded to more than one pharmacological treatment, they premenstrual dysphoric disorder in a community sample of young women:
should be reassessed for potential underlying psychiatric or the role of traumatic events and posttraumatic stress disorder. J Clin
medical disorders, therefore highlighting the importance of Psychiatry 2004;65:1314–22.
15 Stevinson C, Ernst E. Complementary/alternative therapies for premenstrual
regular patient review following initiation of treatment. syndrome: a systematic review of randomized controlled trials. Am J Obstet
Gynecol 2001;185:227–34.
Contribution of authorship 16 Schellenberg R. Treatment for the premenstrual syndrome with agnus
castus fruit extract: prospective, randomised, placebo controlled study. BMJ
SW: extensive literature search around the topic, and 2001;322:134–7.
significant contribution to the writing of the main article, 17 Royal College of Obstetricians and Gynaecologists. Premenstrual syndrome,
as well as referencing, and creation of several of the CPD Management (Green-top Guideline No. 48). London:RCOG; 2007 [https://
www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg48/].
questions. EI: creation of several of the CPD questions, 18 Dimmock PW, Wyatt KM, Jones PW, O’Brien PM. Efficacy of selective
appraisal of the article content and construction of the serotonin-reuptake inhibitors in premenstrual syndrome: a systematic
abstract. BN: contribution into the design of the article, with review. Lancet 2000;356:1131–6.
19 Wikander I, Sundblad C, Andersch B, Dagnell I, Zylberstein D, Bengtsson
contribution in to the content and critical appraisal of the F, et al. Citalopram in premenstrual dysphoria: is intermittent treatment
overall article, as well as creation of several CPD questions. during luteal phases more effective than continuous medication
SO: clinical supervisor who came up with the proposed idea throughout the menstrual cycle? J Clin Psychopharmaocol 1998;
18:390–8.
for the paper, with significant input in to the formatting 20 Pearlstein TB, Stone AB, Lund SA, Scheft H, Zlotnick C, Brown WA.
and content. Comparison of fluoxetine, buproprion, and placebo in the treatment of
premenstrual dysphoric disorder. J Clin Psychopharmacol 1997;17:261–5.
21 Cohen LS, Soares CN, Yonkers KA, Bellew KM, Bridges IM, Steiner M.
Disclosure of interests Paroxetine controlled release for premenstrual dysphoric disorder: a double-
None blind, placebo-controlled trial. Psychosom Med 2004;66:707–13.
22 Jermain DM, Preece CK, Sykes RL, Kuehl TJ, Sulak PJ. Luteal phase
sertraline treatment for premenstrual dysphoric disorder. Results of a
References double-blind, placebo-controlled, crossover study. Arch Fam Med
1999;8:328–32.
1 O’Brien PMS, B€ackstr€om T, Brown C, Dennerstein L, Endicott J, Epperson 23 Marjoribanks J, Brown J, O’Brien PM, Wyatt K. Selective serotonin reuptake
CN, et al. Towards a consensus on diagnostic criteria, measurement and inhibitors for premenstrual syndrome. Cochrane Database Syst Rev 2013;
trial design of the premenstrual disorders: the ISPMD Montreal consensus. (6):CD001396.
Arch Womens Ment Health 2011;14:13–21. 24 Cohen LS, Miner C, Brown EW, Freeman E, Halbreich U, Sundell K, et al.
2 Yonkers KA, O’Brien PM, Eriksson E. Premenstrual syndrome. Lancet Premenstrual daily fluoxetine for premenstrual dysphoric disorder: a
2008;371:1200–10. placebo-controlled, clinical trial using computerized diaries. Obstet Gynecol
3 Dhingra V, O’Brien SPM. Quantification of premenstrual syndrome and 2002;100:435–44.
premenstrual dysphoric disorder. In: O’Brien PMS, Rapkin A, Schmidt P, 25 Halbreich U, Bergeron R, Yonkers KA, Freeman E, Stout AL, Cohen L.
editors. The Premenstrual Syndromes: PMS and PMDD. London: Informa Efficacy of intermittent, luteal phase sertraline treatment of premenstrual
Healthcare; 2007. p. 27–36. dysphoric disorder. Obstet Gynecol 2002;100:1219–29.
26 Miner C, Brown E, McCray S, Gonzales J, Wohlreich M. Weekly luteal-phase 34 Pearlstein TB, Bachmann GA, Zacur HA, Yonkers KA. Treatment
dosing with enteric-coated fluoxetine 90 mg in premenstrual dysphoric of premenstrual dysphoric disorder with a new drospirenone-
disorder: a randomized, double-blind, placebo-controlled clinical trial. Clin containing oral contraceptive formulation. Contraception 2005;
Ther 2002;24:417–33. 72:414–21.
27 Landen M, Nissbrandt H, Allgulander C, So€rvik K, Ysander C, Eriksson E. 35 Ford O, Lethaby A, Roberts H, Mol BWJ. Progesterone for
Placebo-controlled trial comparing intermittent and continuous paroxetine premenstrual syndrome. Cochrane Database Syst Rev 2012;(3):
in premenstrual dysphoric disorder. Neuropsychopharmacology CD003415.
2007;32:153–61. 36 Graham CA, Sherwin BB. A prospective treatment study of premenstrual
28 Watson NR, Studd JW, Savvas M, Garnett T, Baber RJ. Treatment of severe symptoms using a triphasic oral contraceptive. J Psychosom Res
premenstrual syndrome with oestradiol patches and cyclical oral 1992;36:257–66.
norethisterone. Lancet 1989;2:730–2. 37 Wyatt KM, Dimmock PW, Ismail KM, Jones PW, O’Brien PM. The
29 Yonkers , O’Brien PM, Eriksson E. Premenstrual syndrome. Lancet effectiveness of GnRHa with and without ‘add-back’ therapy in
2008;371:1200–10. treating premenstrual syndrome: a meta analysis. BJOG 2004;
30 De Lignieres B. Oral micronized progesterone. Clin Ther 1999;21:41–60; 111:585–93.
discussion 1-2. 38 Cronje WH, Vashisht A, Studd JW. Hysterectomy and bilateral
31 Magos AL, Brincat M, Studd JW. Treatment of the premenstrual syndrome oophorectomy for severe premenstrual syndrome. Hum Reprod
by subcutaneous estradiol implants and cyclical oral norethisterone: 2004;19:2152–5.
placebo-controlled study. BMJ 1986;292:1629–33. 39 Casper RF, Hearn MT. The effect of hysterectomy and bilateral
32 Yonkers KA, Brown C, Pearlstein TB, Foegh M, Sampson-Landers C, Rapkin oophorectomy on women with severe premenstrual syndrome. Am J Obstet
A. Efficacy of a new low-dose oral contraceptive with drospirenone in Gynecol 1990;162:105–109.
premenstrual dysphoric disorder. Obstet Gynecol 2005;106:492–501. 40 Pearlstein T, Joliat MJ, Brown EB, Miner CM. Recurrence of symptoms of
33 Lopez LM, Kaptein AA, Helmerhorst FM. Oral contraceptives containing premenstrual dysphoric disorder after the cessation of luteal-phase
drospirenone for premenstrual syndrome. Cochrane Database of Syst Rev fluoxetine treatment. Am J Obstet Gynecol. 2003 Apr;
2012;(2):CD006586. 188:887–95.