Interdisciplinary consensus on management of premenstrual disorders in switzerland
Keywords:algorithm, consensus, diagnostic, experts, premenstrual dysphoric disorder, premenstrual syndrome, Switzerland, treatment
Premenstrual disorders (PMD) can affect women throughout their entire reproductive years. In 2016, an interdisciplinary expert meeting of general gynecologists, gynecological endocrinologists, psychiatrists and psychologists from Switzerland was held to provide an interdisciplinary algorithm on PMD management taking reproductive stages into account.
Approximately 30–40% of women report premenstrual syndrome symptoms that require treatment, while 3–8% of women during their reproductive years suffer from PMDD.
The core PMD can be subdivided into predominantly somatic symptoms, predominantly psychological symptoms or mixed somatic and psychological symptoms. The most frequent psychological symptoms are mood swings, irritability, anxiety and depression.The Swiss algorithm for PMD management seeks to incorporate the structural level of medical care (primary/secondary care) as well as varying content levels (diagnostics, treatment) depending on the reproductive stage of a woman (reproductive phase, menopausal transition). Primary clinical diagnostics (personal history, prospective symptom assessment) should be performed by the primary PMD care provider. If first- and second-line treatment is not successful, the patient should be refered to a secondary PMD care provider, preferably to a gynecological endocrinologist. A psychiatrist is the preferred secondary PMD care provider if a woman presents with variant PMD with psychiatric co-morbidity. Clinical diagnostics will then be completed by a serum laboratory work-up and eventually Treatment options include cognitive behavioral therapy, alternative therapy, antidepressants, ovulation suppression and diuretics. Treatment choice depends on prevalent PMD symptoms, (reproductive) age, family planning, cardiovascular risk factors, comorbidities, comedication and the woman’s preference. Regular follow-ups are mandatory. In Switzerland, except for chasteberry (Vitex agnus-castus L.) and progesterone none of the following therapeutic options is approved for PMD treatment.
- Landen, M., Eriksson, O., Sundblad, C., et al. “Placebo-controlled trial comparing intermittent and continuous paroxetine in premenstrual dysphoric disorder.” Neuropsychopharmacology 32 (2007): 153–61.
- O’Brien, S., Rapkin, A., Dennerstein, L., et al. “Diagnosis and management of premenstrual disorders. ” BMJ 342 (2011): d2994.
- Ryu, A., Kim, T.H. “Premenstrual syndrome: a mini review.” Maturitas 82 (2015): 436–40.
- Schellenberg, R., Zimmerman, C., Drewe, J., et al. “Dose-dependent efficacy of the Vitex agnus castus extract Ze 440 in patients suffering from premenstrual syndrome.” Phytomedicine 19 (2012): 1325–31.
- Royal College of Obstetricians & Gynaecologists. “Management of premenstrual syndrome.” Green-Top Guideline 48 (2007): 1–16.
- Freeman, E.W., Rickets, K., Sammel, M.D., et al. “Time to relapse after short- or long-term treatment of severe premenstrual syndrome with sertraline.” Arch Gen Psychiatry 66 (2009): 537–44.
- Bailey, J.W., Cohen, L.S. “Prevalence of mood and anxiety disorders in women who seek treatment for premenstrual syndrome.” J Womens Health Gend Based Med 8 (1999): 1181–4.
- Nevatte, T., O’Brien, P.M., Backstrom, T., et al. “ISPMD consensus on the management of premenstrual disorders.” Arch Womens Ment Health 16 (2013): 279–91.
- Maharaj, S., Trevino, K. “A comprehensive review of treatment options for premenstrual syndrome and premenstrual dysphoric disorder.” J Psychiatr Pract 21 (2015): 334–50.
- Shah, N.R., Jones, J.B., Aperi, J., et al. “Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder: a meta-analysis.” Obstet Gynecol 111 (2008): 1175–82.
- van Die, M.D., Burger, H.G., Teede, H.J., Bone, K.M. “Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials.” Planta Med 79 (2013): 562–75.
- Atmaca, M., Kumru, S., Tezcan, E. “Fluoxetine versus Vitex agnus castus extract in the treatment of premenstrual dysphoric disorder.” Hum Psychopharmacol 18 (2003): 191–5.
- Ciotta, L., Pagano, I., Stracquadanio, M., et al. “Psychic aspects of the premenstrual dysphoric disorders. New therapeutic strategies: our experience with Vitex agnus castus.” Minerva Ginecol 63 (2011): 237–45.
- Marjoribanks, J., Brown, J., O’Brien, P.M., et al. “Selective serotonin reuptake inhibitors for premenstrual syndrome.” Cochrane Database Syst Rev 6 (2013): CD001396.
- Freeman, E.W., Rickels, K., Sondheimer, S.J., et al. “Continuous or intermittent dosing with sertraline for patients with severe premenstrual syndrome or premenstrual dysphoric disorder.” Am J Psychiatry 161 (2004): 343–51.
- Lopez, L.M., Kaptein, A., Helmerhorst, F.M. “Oral contraceptives containing drospirenone for premenstrual syndrome.” Cochrane Database Syst Rev 2 (2012): CD006586.
- Wyatt, K.M., Dimmock, P.W., Frischer, M., et al. “The effectiveness of GnRHa with and without ‘add-back’ therapy in treating premenstrual syndrome: a meta analysis.” BJOG 111 (2004): 585–93.
- Elovainio, M., Teperi, J., Aalto, A.M., et al. “Depressive symptoms as predictors of discontinuation of treatment of menorrhagia by levonorgestrel-releasing intrauterine system.” Int J Behav Med 14 (2007): 70–5.
- Ford, O., Lethaby, A., Roberts, H., et al. “Progesterone for premenstrual syndrome.” Cochrane Database Syst Rev 3 (2012): CD003415.
- Vellacott, I.D., Shroff, N.E., Pearce, M.Y., et al. “A double-blind, placebocontrolled evaluation of spironolactone in the premenstrual syndrome.” Curr Med Res Opin 10 (1987): 450–6.
- Wang, M., Hammarback, S., Lindhe, B.A., et al. “Treatment of premenstrual syndrome by spironolactone: a double-blind, placebo-controlled study.” Acta Obstet Gynecol Scand 74 (1995): 803–8.
How to Cite
Copyright (c) 2019 Petra Stute, Christine Bodmer, Ulrike Ehlert, Roger Eltbogen, Ankica Ging, Isabelle Streuli, Michael von Wolff
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.