Women with premenstrual syndrome (PMS) should be offered therapy, experts have said. New guidelines for healthcare workers suggest that women who have a diagnosed case of PMS should be offered cognitive behavioural therapy. Experts from the Royal College of Obstetricians and Gynaecologists (RCOG) have devised the guidance to help those caring for women with the condition. Four in 10 women can suffer symptoms of PMS and 5 per cent to 8 per cent of these will suffer severe PMS, RCOG experts said.
Women can suffer psychological symptoms such as depression, anxiety, irritability, loss of confidence and mood swings. They can also suffer from physical symptoms including bloating and breast pain. The new guidelines say that a diagnosis can be made if symptoms are severe enough to impact on a woman or girl's “daily functioning” or interfere with work, school performance or relationships. For a first line treatment, cognitive behavioural therapy should be offered, the guidelines state. Vitamin B6 should also be considered. Meanwhile, antidepressants and continuous use of the contraceptive pill should be considered when planning care. Second line treatment options include oestrogen patches or higher doses of antidepressants. As a last resort surgery can be considered, the guidance adds. If this step is necessary, both the ovaries and womb should be removed, the authors said.
The guidelines also add that there is little evidence to support the use of complementary medicines as a treatment option for PMS, and some may even interact with other medications. “PMS can be a serious condition which can dramatically impact on the quality of a woman's life, affecting her personal and professional life, therefore it is essential that an integrated holistic approach to treatment is adopted,” said Shaughn O'Brien, professor of obstetrics and gynaecology at Keele University and lead author of the guidelines.
“Whilst many women can be treated by their GP by adopting lifestyle changes, taking the contraceptive pill, SSRIs (selective serotonin reuptake inhibitors) or vitamin B6, some women will need more complex care provided by a team of GPs, gynaecologists, psychiatrists and dieticians.
“In the most extreme cases, PMS can lead to self-harm and suicide.
“We hope that these guidelines go some way in raising awareness of the seriousness of the condition and available treatment options, not only in women but also among healthcare professionals.”
Dr Trudi Seneviratne, chairwoman of the Royal College of Psychiatrists' Perinatal Faculty, said: “Cognitive behavioural therapy is well known as an effective treatment for depression and anxiety.
“It may prove helpful for women suffering with severe PMS, but there is not currently a wide evidence base for its use in treating the condition.”