Clinical Scenario

Premenstrual syndrome encompasses physical and psychological symptoms arising in the luteal phase of the menstrual cycle. When symptoms reach moderate to severe intensity, a structured pharmacological or psychological management strategy is indicated.

Treatment Approach

Management of moderate to severe PMS may involve a psychological approach — including SSRI antidepressants and/or cognitive behavioural therapy — alongside or as an alternative to hormonal cycle suppression strategies; the full protocol specifies which interventions apply, in what combination, and under what conditions.

References

In view of their proven efficacy and safety in adults, SSRIs should be considered one of the first line pharmaceutical management options in severe PMS.
When treating women with severe PMS, cognitive behavioural therapy should be considered routinely as a treatment option.
When treating women with PMS, newer contraceptive pill types may represent effective treatment for PMS and should be considered as one of the first-line pharmaceutical interventions.
Percutaneous estradiol, either as an implant or as a patch, combined with cyclical progestogen, has been shown to be effective for the management of physical and psychological symptoms of severe PMS.

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What Is the Treatment of Moderate to Severe Premenstrual Syndrome (PMS)?

References