Current Psychiatry Reports

, Volume 3, Issue 6, pp 463–469

Current management of premenstrual syndrome and premenstrual dysphoric disorder

  • Leslie Born
  • Meir Steiner
Article

Abstract

About 5% of women of reproductive age experience affective or physical premenstrual symptoms that markedly influence work, social activities, or relationships. Prospective charting of symptoms for at least two menstrual cycles is required to facilitate an accurate diagnosis of premenstrual syndrome or premenstrual dysphoric disorder. The optimal treatment plan begins with lifestyle modifications, followed by pharmacotherapy. Evidence from numerous controlled trials has clearly demonstrated that low-dose serotonin reuptake inhibitors, using intermittent or continuous administration, have excellent efficacy with minimal side effects. Modification of the menstrual cycle should be considered only after all other treatment options have failed.

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References and Recommended Reading

  1. 1.
    Johnson SR, McChesney C, Bean JA: Epidemiology of premenstrual symptoms in a nonclinical sample: I. Prevalence, natural history and help-seeking behaviour. J Reprod Med 1988, 33:340–346.PubMedGoogle Scholar
  2. 2.
    Budeiri DJ, Li Wan Po A, Dornan JC: Clinical trials of treatments of premenstrual syndrome: entry criteria and scales for measuring treatment outcomes. Br J Obstet Gynaecol 1994, 101:689–695.PubMedGoogle Scholar
  3. 3.
    World Health Organization: International Statistical Classification of Diseases and Related Problems, vol 10 (ICD-10). Geneva: World Health Organization Press; 1992.Google Scholar
  4. 4.
    Ramcharan S, Love EJ, Fick GH, Goldfien A: The epidemiology of premenstrual symptoms in a population based sample of 2650 urban women: attributable risk and risk factors. J Clin Epidemiol 1992, 45:377–392.PubMedCrossRefGoogle Scholar
  5. 5.
    Sveindòttir H, Bäckström T: Prevalence of menstrual cycle symptom cyclicity and premenstrual dysphoric disorder in a random sample of women using and not using oral contraceptives. Acta Obstet Gynecol Scand 2000, 79:405–413. The sole study to ascertain that premenstrual symptom cyclicity is similar in women using and not using oral contraceptivesPubMedCrossRefGoogle Scholar
  6. 6.
    Angst J, Sellaro R, Stolar M, et al.: The epidemiology of perimenstrual psychological symptoms. Acta Psychiatr Scand 2001, 104:110–116.PubMedCrossRefGoogle Scholar
  7. 7.
    Johnson SR: The epidemiology and social impact of premenstrual symptoms. Clin Obstet Gynecol 1987, 30:367–376.PubMedCrossRefGoogle Scholar
  8. 8.
    Pearlstein TB, Halbreich U, Batzar ED, et al.: Psychosocial functioning in women with premenstrual dysphoric disorder before and after treatment with sertraline or placebo. J Clin Psychiatry 2000, 61:101–109. The first random controlled trial to include a prospective measure of psychosocial functioning in response to treatment.PubMedCrossRefGoogle Scholar
  9. 9.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 3, Rev ed. Washington, DC: American Psychiatric Association Press; 1987:367–369.Google Scholar
  10. 10.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association Press; 1994:715–718.Google Scholar
  11. 11.
    Roca CA, Schmidt PJ, Bloch M, Rubinow DR: Implications of endocrine studies of premenstrual syndrome. Psychiatr Ann 1996, 26:576–580.Google Scholar
  12. 12.
    Kendler KS, Karkowski LM, Corey LA, Neale MC: Longitudinal population-based twin study of retrospectively reported premenstrual symptoms and lifetime major depression. Am J Psychiatry 1998, 155:1234–1240. A benchmark report on the heritability of premenstrual symptoms (estimated at 56%), establishing that genetic and environmental risk factors which contribute to both PMS and lifetime major depression are not closely related.PubMedGoogle Scholar
  13. 13.
    Schmidt PJ, Nieman LK, Danaceau MA, et al.: Differential behavioral effects of gonadal steroids in women with and in those without premenstrual syndrome. N Engl J Med 1998, 338:209–216.PubMedCrossRefGoogle Scholar
  14. 14.
    Casper RF, Hearn MT: The effect of hysterectomy and bilateral oophorectomy in women with severe premenstrual syndrome. Am J Obstet Gynecol 1990, 162:105–109.PubMedGoogle Scholar
  15. 15.
    Casson P, Hahn PM, Van Vugt DA, Reid RL: Lasting response to ovariectomy in severe intractable premenstrual syndrome. Am J Obstet Gynecol 1990, 162:99–105.PubMedGoogle Scholar
  16. 16.
    Rapkin AJ: The role of serotonin in premenstrual syndrome. Clin Obstet Gynecol 1992, 35:629–636.PubMedCrossRefGoogle Scholar
  17. 17.
    Steiner M, Lepage P, Dunn EJ: Serotonin and gender-specific psychiatric disorders. Int J Psych Clin Prac 1997, 1:3–13.Google Scholar
  18. 18.
    Endicott J: The menstrual cycle and mood disorders. J Affect Disord 1993, 29:193–200.PubMedCrossRefGoogle Scholar
  19. 19.
    Pearlstein TB, Frank E, Rivera-Tovar A, et al.: Prevalence of axis I and axis II disorders in women with late luteal phase dysphoric disorder. J Affect Disord 1990, 20:129–134.PubMedCrossRefGoogle Scholar
  20. 20.
    Wurtman JJ: Depression and weight gain: The serotonin connection. J Affect Disord 1993, 29:183–192.PubMedCrossRefGoogle Scholar
  21. 21.
    Cohen IR, Wise PM: Effects of estradiol on the diurnal rhythm of serotonin activity in microdissected brain areas of ovariectomized rats. Endocrinology 1988, 122:2619–2625.PubMedGoogle Scholar
  22. 22.
    Ladisich W: Influence of progesterone on serotonin metabolism: a possible causal factor for mood changes. Psychoneuroendocrinology 1977, 2:257–266.PubMedCrossRefGoogle Scholar
  23. 23.
    Bancroft J, Cook A, Davidson D, et al.: Blunting of neuroendocrine responses to infusion of L-tryptophan in women with perimenstrual mood change. Psychol Med 1991, 21:305–312.PubMedCrossRefGoogle Scholar
  24. 24.
    Yatham LN: Is 5HT-1a receptor sub-sensitivity a trait marker for late luteal phase dysphoric disorder? A pilot study. Can J Psychiatry 1993, 38:662–664.PubMedGoogle Scholar
  25. 25.
    FitzGerald M, Malone KM, Li S, et al.: Blunted serotonin response to fenfluramine challenge in premenstrual dysphoric disorder. Am J Psychiatry 1997, 154:556–558.PubMedGoogle Scholar
  26. 26.
    Steiner M, Yatham LN, Coote M, et al.: Serotonergic dysfunction in women with pure premenstrual dysphoric disorder: is the fenfluramine challenge test still relevant? Psychiatry Res 1999, 87:107–115.CrossRefPubMedGoogle Scholar
  27. 27.
    Bancroft J, Cook A: The neuroendocrine response to d-fenfluramine in women with premenstrual depression. J Affect Disord 1995, 36:57–64.PubMedCrossRefGoogle Scholar
  28. 28.
    Paddison PL, Gise LH, Lebovits A, et al.: Sexual abuse and premenstrual syndrome: comparison between lower and higher socioeconomic group. Psychosomatics 1990, 31:265–272.PubMedGoogle Scholar
  29. 29.
    Reid RL: Premenstrual syndrome. Curr Probl Obstet Gynecol Fertil 1985, 8:1–57.Google Scholar
  30. 30.
    Mortola JF, Girton L, Beck L, Yen SS: Diagnosis of premenstrual syndrome by a simple, prospective, and reliable instrument: the calendar of premenstrual experiences. Obstet Gynecol 1990, 76:302–307.PubMedGoogle Scholar
  31. 31.
    Freeman EW, DeRubeis RJ, Rickels K: Reliability and validity of a daily diary for premenstrual syndrome. Psychiatry Res 1996, 65:97–106.PubMedCrossRefGoogle Scholar
  32. 32.
    Steiner M, Streiner DL, Steinberg S, et al.: The measurement of premenstrual mood symptoms. J Affect Disord 1999, 53:269–273. Validated screening and diagnostic tools are now available to help the clinician in the identification of women with premenstrual syndromes. The authors examined the reliability, validity, and sensitivity to change in three prospective rating scales.PubMedCrossRefGoogle Scholar
  33. 33.
    Steiner M, Wilkins A: Diagnosis and assessment of premenstrual dysphoria. Psychiatr Ann 1996, 26:571–575.Google Scholar
  34. 34.
    Stevinson C, Ernst E: Complementary/alternative therapies for premenstrual syndrome: a systematic review of randomized controlled trials. Am J Obstet Gynecol 2001, 185:227–235. A comprehensive overview of alternative therapies for premenstrual syndromes. The report shows that the evidence (despite popular belief) is not compelling for any one alternative therapy.PubMedCrossRefGoogle Scholar
  35. 35.
    Pearlstein T, Steiner M: Non-antidepressant treatment of premenstrual syndrome. J Clin Pyschiatry 2000, 61(suppl):22–27.Google Scholar
  36. 36.
    Johnson WG, Carr-Nangle RE, Bergeron KC: Macronutrient intake, eating habits, and exercise as moderators of menstrual distress in healthy women. Psychosom Med 1995, 57:324–330.PubMedGoogle Scholar
  37. 37.
    Prior JC, Vigna V, Sciarretta D, et al.: Conditioning exercise decreases premenstrual symptoms: a prospective, controlled 6-month trial. Fertil Steril 1987, 47:402–408.PubMedGoogle Scholar
  38. 38.
    Blake F, Salkovskis P, Gath D, et al.: Cognitive therapy for premenstrual syndrome: a controlled trial. J Psychosom Res 1998, 45:307–318.PubMedCrossRefGoogle Scholar
  39. 39.
    Lam RW, Carter D, Misri S, et al.: A controlled study of light therapy in women with late luteal phase dysphoric disorder. Psychiatry Res 1999, 86:185–192.PubMedCrossRefGoogle Scholar
  40. 40.
    Thys-Jacobs S, Starkey P, Bernstein D, Tian J: Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Am J Obstet Gynecol 1998, 179:444–452. Calcium may be a viable nonprescription alternative treatment. In this multicenter study, with a sample of 466 women, calcium carbonate has been shown to decrease total symptom scores by 48% compared with a 30% reduction seen in the group on placebo. The results warrant replication.PubMedCrossRefGoogle Scholar
  41. 41.
    Walker AF, DeSouza MC, Vickers MF, et al.: Magnesium supplementation alleviates premenstrual symptoms of fluid retention. J Womens Health. 1998, 7:1157–1165.PubMedCrossRefGoogle Scholar
  42. 42.
    Wyatt KM, Dimmock PW, Jones PW, O’Brien PMS: Efficacy of vitamin B6 in the treatment of premenstrual syndrome: systematic review. BMJ 1999, 318:1375–1381. Vitamin B6 may also be a viable nonprescription alternative treatment. The results suggest that vitamin B6 is of moderate benefit in treating PMS. It is about twice as likely as placebo to relieve overall symptoms, and about one and half times as likely as placebo to relieve premenstrual depression.PubMedGoogle Scholar
  43. 43.
    Schellenberg R: Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomized, placebo controlled study. BMJ 2001, 322:134–137.PubMedCrossRefGoogle Scholar
  44. 44.
    Steiner M, Steinberg S, Stewart D, et al.: Fluoxetine in the treatment of premenstrual dysphoria. N Engl J Med 1995, 332:1529–1534.PubMedCrossRefGoogle Scholar
  45. 45.
    Su T-P, Schmidt PJ, Danaceau MA, et al.: Fluoxetine in the treatment of premenstrual dysphoria. Neuropsychopharmacol 1997, 16:346–356.CrossRefGoogle Scholar
  46. 46.
    Pearlstein TB, Stone AB, Lund SA, et al.: Comparison of fluoxetine, bupropion, and placebo in the treatment of premenstrual dysphoric disorder. J Clin Psychopharmacol 1997, 17:261–266.PubMedCrossRefGoogle Scholar
  47. 47.
    Steiner M, Korzekwa M, Lamont J, Wilkins A: Intermittent fluoxetine dosing in the treatment of women with premenstrual dysphoria. Psychopharmacol Bull 1997, 33:771–774.PubMedGoogle Scholar
  48. 48.
    Diegoli MSC, da Fonseca AM, Diegoli CA, Pinotti J: A doubleblind trial of four medications to treat severe premenstrual syndrome. Int J Gynaecol Obstet 1998, 62:63–67.PubMedCrossRefGoogle Scholar
  49. 49.
    Steiner M, Romano SJ, Babcock S, et al.: The efficacy of fluoxetine in improving physical symptoms associated with premenstrual dysphoric disorder. BJOG 2001, 108:462–468.PubMedCrossRefGoogle Scholar
  50. 50.
    Eriksson E, Hedberg MA, Andersch B, Sundblad C: The serotonin reuptake inhibitor paroxetine is superior to the noradrenaline reuptake inhibitor maprotiline in the treatment of premenstrual syndrome. Neuropsychopharmacology 1995, 12:167–176.PubMedCrossRefGoogle Scholar
  51. 51.
    Sundblad C, Wikander I, Andersch B, Eriksson E: A naturalistic study of paroxetine in premenstrual syndrome: efficacy and side-effects during ten cycles of treatment. Eur Neuropsychopharmacol 1997, 7:201–206.PubMedCrossRefGoogle Scholar
  52. 52.
    Yonkers KA, Halbreich U, Freeman E, et al.: Symptomatic improvement of premenstrual dysphoric disorder with sertraline treatment: a randomized controlled trial. JAMA 1997, 278:983–988.PubMedCrossRefGoogle Scholar
  53. 53.
    Freeman EW, Rickels K, Sodheimer SJ, Polansky M: Differential response to antidepressants in women with premenstrual syndrome/premenstrual dysphoric disorder: a randomized controlled trial. Arch Gen Psychiatry 1999, 56:932–939.PubMedCrossRefGoogle Scholar
  54. 54.
    Halbreich U, Bergeron R, Stout A, et al.: Intermittent luteal phase dosing of sertraline is effective in premenstrual dysphoric disorder. Abstract presented at the Annual Meeting of the American Psychiatric Association; Chicago. 2000;Google Scholar
  55. 55.
    Jermain DM, Preece CK, Sykes RL, et al.: Luteal phase sertraline treatment for premenstrual dysphoric disorder: results of a double blind, placebo-controlled, crossover study. Arch Fam Med 1999, 8:328–332.PubMedCrossRefGoogle Scholar
  56. 56.
    Freeman EW, Rickels K, Arredondo F, et al.: Full or half-cycle treatment of severe premenstrual syndrome with a serotonergic antidepressant. J Clin Psychopharmacol 1999, 19:3–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Wikander I, Sundblad C, Andersch B, et al.: Citalopram in premenstrual dysphoria: is intermittent treatment during luteal phases more effective than continuous medication throughout the menstrual cycle? J Clin Psychopharmacol 1998, 18:390–398.PubMedCrossRefGoogle Scholar
  58. 58.
    Freeman EW, Sondheimer SJ, Rickels K, et al.: Efficacy and safety of venlafaxine for premenstrual dysphoric disorder. Obstet Gynecol 2001, 97(suppl):S9-S10.CrossRefGoogle Scholar
  59. 59.
    Sundblad C, Modigh K, Andersch B, Eriksson E: Clomipramine effectively reduces premenstrual irritability and dysphoria: a placebo controlled trial. Acta Psychiatr Scand 1992, 85:39–47.PubMedGoogle Scholar
  60. 60.
    Sundblad C, Hedberg MA, Eriksson E: Clomipramine administered during the luteal phase reduces the symptoms of premenstrual syndrome: a placebo-controlled trial. Neuropsychopharmacology 1993, 9:133–145.PubMedGoogle Scholar
  61. 61.
    Steinberg S, Annable L, Young SN, Hiyanage N: A placebo controlled clinical trial of L-tryptophan in premenstrual dysphoria. Biol Psychiatry 1999, 45:313–320.PubMedCrossRefGoogle Scholar
  62. 62.
    Brown CS, Parker N, Ling F, Wan J: Sertraline in contraceptive users with premenstrual dysphoric disorder. Obstet Gynecol 2000, 95(suppl):29S.Google Scholar
  63. 63.
    Smith S, Rinehart JS, Ruddock VE, Schiff I: Treatment of premenstrual syndrome with alprazolam: results of a double-blind, placebo-controlled, randomized crossover clinical trial. Obstet Gynecol 1987, 70:37–43.PubMedGoogle Scholar
  64. 64.
    Berger CP, Presser B: Alprazolam in the treatment of two subsamples of patients with late luteal phase dysphoric disorder: a double-blind, placebo-controlled crossover study. Obstet Gynecol 1994, 84:379–385.PubMedGoogle Scholar
  65. 65.
    Harrison WM, Endicott J, Nee J: Treatment of premenstrual dysphoria with alprazolam: a controlled study. Arch Gen Psychiatry 1990, 47:270–275.PubMedGoogle Scholar
  66. 66.
    Freeman EW, Rickels K, Sondheimer SJ, Polansky M: A doubleblind trial of oral progesterone, alprazolam, and placebo in the treatment of severe premenstrual syndrome. JAMA 1995, 274:51–57.PubMedCrossRefGoogle Scholar
  67. 67.
    Rickels K, Freeman E, Sondheimer S: Buspirone in treatment of premenstrual syndrome. Lancet 1989, 1:777.PubMedCrossRefGoogle Scholar
  68. 68.
    Landén M, Eriksson O, Sundblad C, et al.: Compounds with affinity for serotonergic receptors in the treatment of premenstrual dysphoria: a comparison of buspirone, nefazodone and placebo. Psychopharmacology 2001, 155:292–298.PubMedCrossRefGoogle Scholar
  69. 69.
    Mezrow G, Shoupe D, Spicer D, et al.: Depot leuprolide acetate with estrogen and progestin add-back for long-term treatment of premenstrual syndrome. Fertil Steril 1994, 62:932–937.PubMedGoogle Scholar
  70. 70.
    Hussain SY, Massil JH, Matta WH, et al.: Buserelin in premenstrual syndrome. Gynecol Endocrinol 1992, 6:57–64.PubMedGoogle Scholar
  71. 71.
    Brown CS, Ling FW, Andersen RN, et al.: Efficacy of depot leuprolide in premenstrual syndrome: effect of symptom severity and type in a controlled trial. Obstet Gynecol 1994, 84:779–786.PubMedGoogle Scholar
  72. 72.
    Freeman EW, Sondheimer SJ, Rickels K: Gonadotropinreleasing hormone agonist in the treatment of premenstrual symptoms with and without ongoing dysphoria: a controlled study. Psychopharmacol Bull 1997, 33:303–309.PubMedGoogle Scholar
  73. 73.
    Di Carlo C, Palomba S, Tommaselli GA, et al.: Use of leuprolide acetate plus tibolone in the treatment of severe premenstrual syndrome. Fertil Steril 2001, 75:380–384.PubMedCrossRefGoogle Scholar
  74. 74.
    Hahn PM, Van Vugt DA, Reid RL: A randomized, placebocontrolled, crossover trial of danazol for the treatment of premenstrual syndrome. Psychoneuroendocrinology 1995, 20:193–209.PubMedCrossRefGoogle Scholar
  75. 75.
    O’Brien PM, Abukhalil IE: Randomized controlled trial of the management of premenstrual syndrome and premenstrual mastalgia using luteal phase only danazol. Am J Obstet Gynecol 1999, 180:18–23.PubMedCrossRefGoogle Scholar
  76. 76.
    Graham CA, Sherwin BB: A prospective treatment study of premenstrual symptoms using a triphasic oral contraceptive. J Psychosom Res 1992, 36:257–266.PubMedCrossRefGoogle Scholar
  77. 77.
    Freeman EW, Kroll R, Rapkin A, et al.: Evaluation of a unique oral contraceptive in the treatment of premenstrual dysphoric disorder. J Womens Health Gend Based Med 2001, 10:561–569.PubMedCrossRefGoogle Scholar
  78. 78.
    Eriksson E: Serotonin reuptake inhibitors for the treatment of premenstrual dysphoria. Int Clin Psychopharmacol 1999, 14:S27-S33.PubMedGoogle Scholar
  79. 79.
    Dimmock PW, Wyatt KM, Jones PW, O’Brien PMS: Efficacy of selective serotonin-reuptake inhibitors in premenstrual syndrome: a systematic review. Lancet 2000, 356:1131–1136. An elegant meta-analysis that showed that an SSRI was about seven times more effective than placebo in the treatment of physical and behavioral symptoms of severe PMS. However, withdrawal due to side effects was 2.5 times more likely to occur in the group assigned an SSRI. The most common side effects were insomnia, gastrointestinal disturbances, and fatigue, with the higher dose range accounting for most of the reported side effects.PubMedCrossRefGoogle Scholar
  80. 80.
    Steiner M, Born L: Advances in the diagnosis and treatment of premenstrual dysphoria. CNS Drugs 2000, 13:287–304.CrossRefGoogle Scholar
  81. 81.
    Freeman EW, Jabara S, Sondheimer SJ, Auletto R: A pilot study of the effectiveness of citalopram in patients with premenstrual syndrome with prior selective serotonin reuptake inhibitor treatment failure. Obstet Gynecol 2001, 97(suppl):S18.CrossRefGoogle Scholar
  82. 82.
    Endicott J, Amsterdam J, Eriksson E, et al.: Is premenstrual dysphoric disorder a distinct clinical entity? J Womens Health Gend Based Med 1999, 8:663–679. A report of a roundtable discussion with an international panel of experts who reviewed information on the distinctiveness of PMDD compared with other disorders, in particular major depression. The consensus of the group was that PMDD is a distinct clinical entity. The key issues in the decision-making are neatly summarized.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2001

Authors and Affiliations

  • Leslie Born
    • 1
  • Meir Steiner
    • 1
  1. 1.Women’s Health Concerns Clinic, St. Joseph’s HealthcareHamiltonCanada

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