Women experiencing premenstrual syndrome should routinely be offered cognitive behavioural therapy to help them manage the symptoms, gynaecologists have said.

Around 40% of women experience symptoms of PMS with around 5%-8% having severe symptoms. Physical symptoms can include swollen breasts and bloating, and the psychological symptoms are wide-ranging, including depression, irritability, suicidal thoughts and loss of confidence. The condition can be debilitating, disrupting school, social and work life.

Now the Royal College of Obstetricians and Gynaecologists has released a set of guidelines reiterating the role of CBT in helping women manage their symptoms.

“There is a very, very marked and important psychological element of the problem,” said Shaughn O’Brien, professor of obstetrics and gynaecology at Keele University, chairman of the International Society for Premenstrual Disorders and lead author of the new guidelines.

The publication, which updates previous guidance incorporating the latest evidence, recommends: “When treating women with severe PMS, CBT should be considered routinely as a treatment option,” with the authors adding that the use of CBT could avoid the need for PMS to be tackled with drugs and remove the possibility of potential side-effects.



While the guidelines emphasise the benefits of CBT, they also note that combined oral contraceptives, vitamin B6 and antidepressants known as SSRIs can be used to manage PMS symptoms in the first line of treatment. Oestrogen patches are included among the options for the second line of treatment while the third line includes the use of synthetic hormones known as gonadotrophin-releasing hormone (GnRH) analogues – a treatment recommended only for women with the most severe symptoms.

But as O’Brien points out, only the removal of the womb and ovaries will resolve the issue permanently. “It is actually the only cure but it is very drastic,” he said.

The guidelines also advise of the limited evidence for the use of complementary medicines in managing PMS, adding that interactions with conventional medicines should also be flagged.

While PMS affects a large proportion of women, the exact mechanism behind the condition remains unclear. “We know that ovulation and the hormone cycle causes [PMS], but we don’t know why,” said O’Brien, pointing out that there appears to be little difference in the levels of the hormone progesterone between women who do experience PMS to those who do not.

“The difference must be in the way the body and particularly the brain responds to those normal progesterone levels,” he said.