Am Fam Physician. 2024;110(6):647-650
Author disclosure: No relevant financial relationships.
KEY POINTS FOR PRACTICE
• SSRIs moderately improve psychological symptoms, irritability, and function, even with intermittent dosing during the luteal phase.
• Combined oral contraceptives moderately improve premenstrual symptoms other than depressive symptoms.
• CBT improves the affective symptoms of PMS and appears to be as effective as fluoxetine for premenstrual dysphoric disorder.
• For severe premenstrual symptoms, gonadotropin-releasing hormone agonists improve symptoms, even when taking add-back estrogen and progestin to mitigate hypoestrogenic effects.
From the AFP Editors
Premenstrual disorders comprise a spectrum of conditions that occur discretely in the luteal phase of menstruation and resolve during or shortly after menstruation. Up to 90% of reproductive-aged women experience at least one premenstrual symptom, and up to 30% experience a constellation of physical and affective symptoms severe enough to affect daily functioning (ie, premenstrual syndrome [PMS]). Approximately 5% of reproductive-aged women report severe, disabling cyclic affective symptoms classified as premenstrual dysphoric disorder. Premenstrual disorders may be even more common in adolescents. These disorders are often untreated, with one study showing that three-fourths of women with premenstrual disorders not having had any treatment in the past 5 years. The American College of Obstetricians and Gynecologists has released recommendations for the management of premenstrual disorders in reproductive-aged adults and adolescents.
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