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Premenstrual Syndrome
How is PMS diagnosed?
- Symptoms should be recorded prospectively, over at least 2 cycles using a symptoms diary (retrospective recall is unreliable)
- A symptom diary should be commenced by the patient prior to receiving treatment
- Gonadotrpohin-releasing Hormone (GnRH) analogues may be used for 3 months for a definitive diagnosis if the completed symptom diary alone is inconclusive
How is PMS managed?
Women should be informed that there is conflicting evidence to support the use of some complementary medicines. Interactions with conventional medicines should be considered.
An integrated holistic approach should be used when treating women with PMS. When treating women with severe PMS, CBT should routinely be considered as a treatment option.
When treating women with PMS, drospirenone-containing COCs may represent effective treatment and should be considered as a first line pharmaceutical intervention. Emerging data suggests the use of the contraceptive pill continuously rather then cyclically.
Percutaneous oestrodial combined with cyclical progestrogens has been shown to be effective for the management of physical and psychological symptoms of severe PMS. Alternative barrier or intrauterine methods of contraception should be used when percutaneous oestrodiol is used to suppress ovulation
Referral
Women with severe PMS may benefit from being managed by a multidisciplinary team comprising a general practitioner, a general gynaecologist or a gynaecologist with a special interest in PMS, a mental health professional (psychiatrist, clinical psychologist or counsellor) and a dietitian
referral to a gynaecologist should be considered with simple measures (e.g. combined oral contraceptives, Vitamin B6, selective serotonin reuptake inhibitors) have been explored and failed and when the severity of the PMS justifies gynaecological intervention