Evidence-Based Management

of Premenstrual Disorders (PMDs)

This guide is intended primarily as a resource for health care providers and was prepared by the IAPMD Clinical Advisory Board, under the direction of Dr. Tory Eisenlohr-Moul.

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Premenstrual disorders such as premenstrual dysphoric disorder (PMDD) and premenstrual exacerbation (PME) of psychiatric disorders are complex to diagnose and treat effectively. Below, we provide guidelines to help health care providers educate and treat their patients effectively.

Assessment and Diagnosis of PMDs: Ultimately, each patient with premenstrual symptoms is unique, and deserves a compassionate health care provider who will work with them to find an effective treatment--or set of treatments-- for their unique needs. Given that PME often predicts poor response to first-line PMDD treatments (see below), prospective diagnosis using two months of daily symptom ratings is recommended to differentiate between PMDD (symptoms present only premenstrually), PME (symptoms always present but worsened premenstrually), and non-cyclical symptoms. Daily ratings can also be continued in the context of treatment in order to evaluate effectiveness over time. A daily symptom rating form can be downloaded here. Standardized scoring of these daily ratings to determine diagnosis can be accomplished using the C-PASS scoring system. Please note that it is possible to have both PMDD (five symptoms that are present only in the luteal phase) and also PME of other underlying disorders.

Treatment of PMDs: Since this is a relatively new area of medical science, the number of randomized controlled trials for PMDs remain relatively small. However, several treatments have been found to be effective, and more are currently under investigation. Below, we outline what the scientific evidence indicates about how the average person with a premenstrual disorder (typically PMDD-- PME is less well-studied) will respond to various treatments. Many patients utilizing IAPMD services have already tried many of the treatments below with no relief, whereas others have tried none. The purpose of this page is not to provide a “one-size-fits-all” recommendation for the treatment of premenstrual disorders; rather, it is to help those seeking information about effective treatments by reviewing the best evidence about general efficacy and safety of each treatment in those with premenstrual disorders.