PREMENSTRUAL SYNDROME
and PREMENSTRUAL DYSPHORIC DISORDER


I. Proven effective in placebo-controlled trials:

  • Programmed relaxation (Obs. Gyn 75:649, 1990)
  • Serotonin Reuptake Inhibitor Antidepressants
  • Associated with sig. benefit in a meta-analysis of 15 randomized placebo-controlled trials with OR of improvement 6.91 with SRI's c/w placebo; Lancet 356:1131, 2000--JW)
  • In a trial of 167 women 18-45 with PMS randomized to sertaline 50-100mg/d given QD continuously vs. intermittently (starting 14d before menses and continuing until 2d after menses) vs. placebo, x 3mos.  No diff. in treatment response or adverse events between the two sertraline groups; both had higher incidence of treatment response than placebo group for the first 2mos but by the end of the 3rd month the difference was nonsignificant (Am. J. Psychiat. 161:454, 2004--JW)
  • Calcium supplementation: 497 women with PMS randomized to CaCO3 (1.2g/d of elemental Ca) vs. placebo x 3 menstrual cycles; Ca group had sig. lower sx scores than placebo group by 3rd cycle (Am. J. Obs. Gyn. 179:444, 1998--JW)
  • Vitamin B6 at doses of 50-100mg/d appeared more effective than placebo in a meta-analysis of 9 randomized trials involving 940 pts (BMJ 318:1375, 1999--JW)
  • Magnesium 360mg PO QD (Obs. Gyn 78:177, 1991, cited in Contraceptive Tech.)
  • Evening Primrose Oil (Efamol) 1500mg BID from 15th cycle day to menses-provides gamma-linoleic acid and vit. E ; esp. helpful for mastalgia (J. Repro. Med 30:149, 1985, cited in CT)
  • Chaste Tree Extract (Vitex agnus-castus)--170 women meeting DSM III-R criteria for PMS randomized to V. agnus-castus "L extract Ze 440" (20mg casticin QD) vs. placebo x 3 menstrual cycles; sig. greater improvement in sx in active vs. placebo group; no diff. in adverse effects in active vs. placebo groups (BMJ 322:134, 2001--JW)
  • OCP's may be helpful
  • Progestins probably not helpful--In a meta-analysis of 14 randomized trials of progestins for PMS involving total 909 women, only minimal differences in PMS-related symptoms were noted (BMJ 323:776, 2001--JW)
  • II. Premenstrual Dysphoric Disorder is "a syndrome of severe and disabling mood sx that occur before menses." Meds found effective: