Міждисциплінарний консенсус швейцарії щодо ведення пацієнток із передменструальними розладами

Petra Stute; Christine Bodmer; Ulrike Ehlert; Roger Eltbogen; Ankica Ging; Isabelle Streuli; Michael von Wolff

doi:10.18370/2309-4117.2019.48.26-31

Authors

Petra Stute University of Bern, Bern, Switzerland
Christine Bodmer Office for Women’s Health, Bethesda Spital, Basel, Switzerland, Switzerland
Ulrike Ehlert Institute for Psychology, UZH, Zuerich, Switzerland, Switzerland
Roger Eltbogen Swiss Society for Phytotherapy, SMGP, Grunenthal, Waedenswil, Switzerland, Switzerland
Ankica Ging University of Bern, Bern, Switzerland, Switzerland
Isabelle Streuli HUG, Geneva, Switzerland, Switzerland
Michael von Wolff University of Bern, Bern, Switzerland, Switzerland

DOI:

https://doi.org/10.18370/2309-4117.2019.48.26-31

Keywords:

algorithm, consensus, diagnostic, experts, premenstrual dysphoric disorder, premenstrual syndrome, Switzerland, treatment

Abstract

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.

Author Biographies

Petra Stute, University of Bern, Bern

Кафедра акушерства та гінекології

Ankica Ging, University of Bern, Bern, Switzerland

Psychiatry and Psychotherapy

Isabelle Streuli, HUG, Geneva, Switzerland

Unite de medecine de la reproduction et d’endocrinologie gyneґcologique

Michael von Wolff, University of Bern, Bern, Switzerland

Department of Obstetrics and Gynecology, Inselspital

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