“There is a very, very marked and important psychological element of the problem,” said Shaughn O’Brien, professor of obstetrics and gynaecology at Keele University, chairman of the International Society for Premenstrual Disorders and lead author of the new guidelines.
The publication, which updates previous guidance incorporating the latest evidence, recommends: “When treating women with severe PMS, CBT should be considered routinely as a treatment option,” with the authors adding that the use of CBT could avoid the need for PMS to be tackled with drugs and remove the possibility of potential side-effects.
While the guidelines emphasise the benefits of CBT, they also note that combined oral contraceptives, vitamin B6 and antidepressants are known as SSRIs can be used to manage PMS symptoms in the first line of treatment. Oestrogen patches are included among the options for the second line of treatment while the third line includes the use of synthetic hormones known as gonadotropin-releasing hormone (GnRH) analogues – a treatment recommended only for women with the most severe symptoms.
But as O’Brien points out, only the removal of the womb and ovaries will resolve the issue permanently. “It is actually the only cure, but it is very drastic,” he said.
The guidelines also advise of the limited evidence for the use of complementary medicines in managing PMS, adding that interactions with conventional medicines should also be flagged.
While PMS affects a large proportion of women, the exact mechanism behind the condition remains unclear. “We know that ovulation and the hormone cycle causes [PMS], but we don’t know why,” said O’Brien, pointing out that there appears to be little difference in the levels of the hormone progesterone between women who do experience PMS to those who do not.
“The difference must be in the way the body and particularly the brain responds to those normal progesterone levels,” he said.