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WOMEN'S HEALTH

Management Strategies for Premenstrual Syndrome/Premenstrual Dysphoric Disorder

Assistant Professor of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences–Worcester/Manchester, Worcester, MA

Ann M Lynch, PharmD

Assistant Professor of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences–Worcester/Manchester

Anna K Morin, PharmD

Assistant Professor of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences–Worcester/Manchester

Reprints: Dr. Jarvis, Massachusetts College of Pharmacy and Health Sciences–Worcester/Manchester, 19 Foster St., Worcester, MA 01608, fax 508/756-8715, Courtney.Jarvis{at}mcphs.edu

OBJECTIVE: To evaluate the current nonpharmacologic and pharmacologic treatment options for symptoms of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD).

DATA SOURCES: Literature was obtained through searches of MEDLINE Ovid (1950–March week 3, 2008) and EMBASE Drugs and Pharmacology (all years), as well as a bibliographic review of articles identified by the searches. Key terms included premenstrual syndrome, premenstrual dysphoric disorder, PMS, PMDD, and treatment.

STUDY SELECTION/DATA EXTRACTION: All pertinent clinical trials, retrospective studies, and case reports in human subjects published in the English language were identified and evaluated for the safety and efficacy of pharmacologic and nonpharmacologic treatments of PMS/PMDD. Data from these studies and information from review articles were included in this review.

DATA SYNTHESIS: Selective serotonin-reuptake inhibitors (SSRIs) have been proven safe and effective for the treatment of PMDD and are recommended as first-line agents when pharmacotherapy is warranted. Currently fluoxetine, controlled-release paroxetine, and sertraline are the only Food and Drug Administration–approved agents for this indication. Suppression of ovulation using hormonal therapies is an alternative approach to treating PMDD when SSRIs or second-line psychotropic agents are ineffective; however, adverse effects limit their use. Anxiolytics, spironolactone, and nonsteroidal antiinflammatory drugs can be used as supportive care to relieve symptoms. Despite lack of specific evidence, lifestyle modifications and exercise are first-line recommendations for all women with PMS/PMDD and may be all that is needed to treat mild-to-moderate symptoms. Herbal and vitamin supplementation and complementary and alternative medicine have been evaluated for use in PMS/PMDD and have produced unclear or conflicting results. More controlled clinical trials are needed to determine their safety and efficacy and potential for drug interactions.

CONCLUSIONS: Healthcare providers need to be aware of the symptoms of PMS and PMDD and the treatment options available. Treatment selection should be based on individual patient symptoms, concomitant medical history, and need for contraception.

Key Words: premenstrual dysphoric disorder, premenstrual syndrome

Published Online, June 17, 2008. www.theannals.com, DOI 10.1345/aph.1K673

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-08-012-H01-P

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