Management of Premenstrual Dysphoric Disorder: A Scoping Review

Figures & data

Table 1 Diagnosis of Premenstrual Dysphoric Disorder

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: Premenstrual Dysphoric Disorder^Citation1

A. In the majority of menstrual cycles, at least five symptoms must be present in the final week before onset of menses, start to improve within few days after onset of menses, and become minimal or absent in week postmenses. B. One (or more) of the following symptoms must be present: 1. Marked affective lability (eg, mood swings; feeling suddenly sad or tearful or increased sensitivity to rejection). 2. Marked irritability or anger or increased interpersonal conflicts. 3. Marked depressed mood, feelings of hopelessness, or self-deprecating thoughts. 4. Marked anxiety, tension, and/or feelings of being “keyed up”, or “on edge”. C. One (or more) of the following symptoms must additionally be present, to reach a total of five symptoms when combined with symptoms from Criterion B above: 1. Decreased interest in usual activities (eg, work, school, friends, hobbies). 2. Subjective difficulty in concentration. 3. Lethargy, easy fatigability, or marked lack of energy. 4. Marked change in appetite, overeating, or specific food cravings. 5. Hypersomnia or insomnia. 6. A sense of being overwhelmed or out of control. 7. Physical symptoms such as breast tenderness or swelling, joint or muscle pain, sensation of “bloating”, weight gain. Note: The symptoms in Criteria A–C must have been met for most menstrual cycles that occurred in the preceding year. D. The symptoms are associated with clinically significant distress or interferences with work, school, usual social activities, or relationships with others (eg, avoidance of social activities, decreased productivity and efficiency at work, school or home). E. The disturbance is not merely an exacerbation of the symptoms of another disorder such as major depressive disorder, panic disorder, persistent depressive disorder (dysthymia), or a personality disorder (although it may co-occur with any of these disorders). F. Criterion A should be confirmed by prospective daily ratings during at least 2 symptomatic cycles. (Note: The diagnosis may be made provisionally prior to this confirmation.) G. The symptoms are not attributable to the direct physiological effects of a substance (eg, a drug of abuse, a medication other treatment) or another medical condition (eg, hyperthyroidism).

International Society for Premenstrual Disorders: Core Premenstrual Disorder^Citation7

1. Symptoms occur in ovulatory cycles. 2. Symptoms are not specified – they may be somatic and/or psychological. 3. The number of symptoms is not specified. 4. Symptoms are absent after menstruation and before ovulation. 5. They must recur in luteal phase. 6. They must be prospectively rated (two cycles minimum). 7. Symptoms must cause significant impairment.

Figure 1 PRISMA flow diagram.

Table 2 SSRI/SNRI Luteal Phase or Symptom-Onset Dosing Showing Efficacy for Treatment of PMDD

Medication	Dose Range	Dosing Schedule
Sertraline	50 mg to 100 mg daily^Citation30,Citation31	Luteal phase
	50 mg to 100 mg daily^Citation49	Symptom-onset
Escitalopram	10 mg to 20 mg daily^Citation32	Luteal phase
	10 mg to 20 mg daily^Citation33	Symptom-onset
Paroxetine	10 mg to 20 mg daily^Citation36,Citation37	Luteal phase
	12.5 mg to 25 mg daily (controlled release)^Citation38–40
Fluoxetine	10 mg to 20 mg daily^Citation41	Luteal phase
Venlafaxine	75 mg to 112.5 mg daily^Citation51	Luteal phase

Table 3 Oral Complementary and Alternative Medicine Dosing for Treatment of PMS or PMDD

Medication	Dose
Vitex Agnus-Castus	8 mg to 41 mg daily^Citation107–109
Kami-shoyo-san	2.5 g three times per day^Citation113
Saffron	15 mg twice daily^Citation114,Citation115
Hypericum perforatum	600 mg daily^Citation117
Chamomile	100 mg to 400 mg daily^Citation110
Vitamin B6 (pyridoxine)	50 mg to 100 mg dailya,^Citation118,Citation119
Vitamin B1 (thiamine)	100 mg daily^Citation122,Citation123
Vitamin D	*^b
Calcium	500 mg to 1200 mg daily^Citation127–130
Zinc (elemental)	30 mg to 50 mg daily^Citation131,Citation132
Magnesium	250 mg daily^Citation134,Citation135
Omega 3 fatty acids	500 mg to 2000 mg dailyc,^Citation137
Myo-inositol	0.6 mg in gel capsule^Citation138 2 g in powder^Citation138

Notes: ^aHigher doses tested, but upper limit of 100 mg/day recommended for adults. ^bDose suggestion cannot be determined per available evidence. ^cVariable DHA and EPA composition.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

 Google Scholar

O’Brien PMS, Bäckström T, Brown C, et al. Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus. Arch Womens Ment Health. 2011;14(1):13–21. doi:10.1007/s00737-010-0201-3

 PubMed Web of Science ®Google Scholar

Steinberg EM, Cardoso GMP, Martinez PE, Rubinow DR, Schmidt PJ. Rapid response to fluoxetine in women with premenstrual dysphoric disorder. Depress Anxiety. 2012;29(6):531–540. doi:10.1002/da.21959

 Web of Science ®Google Scholar

Pinna G, Costa E, Guidotti A. SSRIs act as selective brain steroidogenic stimulants (SBSSs) at low doses that are inactive on 5-HT reuptake. Curr Opin Pharmacol. 2009;9(1):24–30. doi:10.1016/j.coph.2008.12.006

 Web of Science ®Google Scholar

Yonkers KA, Pearlstein T, Fayyad R, Gillespie JA. Luteal phase treatment of premenstrual dysphoric disorder improves symptoms that continue into the postmenstrual phase. J Affect Disord. 2005;85(3):317–321. doi:10.1016/j.jad.2004.10.006

 Web of Science ®Google Scholar

Gracia CR, Freeman EW, Sammel MD, Lin H, Sheng L, Frye C. Allopregnanolone levels before and after selective serotonin reuptake inhibitor treatment of premenstrual symptoms. J Clin Psychopharmacol. 2009;29(4):403–405. doi:10.1097/JCP.0b013e3181ad8825

 Web of Science ®Google Scholar

Halbreich U, Bergeron R, Yonkers KA, Freeman E, Stout AL, Cohen L. Efficacy of intermittent, luteal phase sertraline treatment of premenstrual dysphoric disorder. Obstet Gynecol. 2002;100(6):1219–1229. doi:10.1016/s0029-7844(02)02326-8

 PubMed Web of Science ®Google Scholar

Freeman EW, Sondheimer SJ, Sammel MD, Ferdousi T, Lin H. A preliminary study of luteal phase versus symptom-onset dosing with escitalopram for premenstrual dysphoric disorder. J Clin Psychiatry. 2005;66(6):769–773. doi:10.4088/JCP.v66n0616

 Web of Science ®Google Scholar

Ladea M, Sarpe MC, Dumitrescu MR. The efficacy and the tolerability of escitalopram in the treatment of premenstrual dysphoric disorder. Gineco.ro. 2008;4(4):253–258.

 Google Scholar

Wu KY, Liu CY, Hsiao MC. Six-month paroxetine treatment of premenstrual dysphoric disorder: continuous versus intermittent treatment protocols. Psychiatry Clin Neurosci. 2008;62(1):109–114. doi:10.1111/j.1440-1819.2007.01785.x

 Web of Science ®Google Scholar

Shah NR, Jones JB, Aperi J, Shemtov R, Karne A, Borenstein J. Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder: a meta-analysis. Obstet Gynecol. 2008;111(5):1175–1182. doi:10.1097/AOG.0b013e31816fd73b

 PubMed Web of Science ®Google Scholar

Schmidt K, Weber N, Steiner M, et al. A lecithin phosphatidylserine and phosphatidic acid complex (PAS) reduces symptoms of the premenstrual syndrome (PMS): results of a randomized, placebo-controlled, double-blind clinical trial. Clin Nutr ESPEN. 2018;24:22–30. doi:10.1016/j.clnesp.2018.01.067

 PubMed Web of Science ®Google Scholar

Es-Haghee S, Shabani F, Hawkins J, et al. The effects of aromatherapy on premenstrual syndrome symptoms: a systematic review and meta-analysis of randomized clinical trials. Evid Based Complement Altern Med. 2020;2020:1–13. doi:10.1155/2020/6667078

 Web of Science ®Google Scholar

Choi JH. Effects of kinesio taping and hot packs on premenstrual syndrome in females. J Phys Ther Sci. 2017;29(9):1514–1517. doi:10.1589/jpts.29.1514

 Google Scholar

Jang HS, Lee MS. Effects of qi therapy (external qigong) on premenstrual syndrome: a randomized placebo-controlled study. J Altern Complement Med. 2004;10(3):456–462. doi:10.1089/1075553041323902

 Web of Science ®Google Scholar

Delaram M, Heydarnejad MS. Herbal remedy for premenstrual syndrome with fennel (Foeniculum vulgare) - Randomized, placebo-controlled study. Adv Clin Exp Med. 2011;20(4):509–512.

 Web of Science ®Google Scholar

Jang HS, Lee MS, Kim MJ, Chong ES. Effects of Qi-therapy on premenstrual syndrome. Int J Neurosci. 2004;114(8):909–921. doi:10.1080/00207450490450163

 Web of Science ®Google Scholar

Jing Z, Yang X, Ismail KMK, Chen X, Wu T. Chinese herbal medicine for premenstrual syndrome. Cochrane Database Syst Rev. 2009;(1). doi:10.1002/14651858.CD006414.pub2

 Web of Science ®Google Scholar

Ibrahim NA, Shalaby AS, Farag RS, Elbaroty GS, Nofal SM, Hassan EM. Gynecological efficacy and chemical investigation of Vitex agnus-castus L. fruits growing in Egypt. Nat Prod Res. 2008;22(6):537–546. doi:10.1080/14786410701592612

 PubMed Web of Science ®Google Scholar

Momoeda M, Sasaki H, Tagashira E, Ogishima M, Takano Y, Ochiai K. Efficacy and safety of vitex agnus-castus extract for treatment of premenstrual syndrome in Japanese patients: a prospective, open-label study. Adv Ther. 2014;31(3):362–373. doi:10.1007/s12325-014-0106-z

 Web of Science ®Google Scholar

Khayat S, Fanaei H, Kheirkhah M, Moghadam ZB, Kasaeian A, Javadimehr M. Curcumin attenuates severity of premenstrual syndrome symptoms: a randomized, double-blind, placebo-controlled trial. Complement Ther Med. 2015;23(3):318–324. doi:10.1016/j.ctim.2015.04.001

 PubMed Web of Science ®Google Scholar

Yamada K, Kanba S. Herbal medicine (Kami-shoyo-san) in the treatment of premenstrual dysphoric disorder [6]. J Clin Psychopharmacol. 2002;22(4):442. doi:10.1097/00004714-200208000-00023

 Web of Science ®Google Scholar

Rajabi F, Rahimi M, Sharbafchizadeh M, Tarrahi M. Saffron for the management of premenstrual dysphoric disorder: a randomized controlled trial. Adv Biomed Res. 2020;9(1):60. doi:10.4103/abr.abr_49_20

 Google Scholar

Agha-Hosseini M, Kashani L, Aleyaseen A, et al. Crocus sativus L. (saffron) in the treatment of premenstrual syndrome: a double-blind, randomised and placebo-controlled trial. BJOG. 2008;115(4):515–519. doi:10.1111/j.1471-0528.2007.01652.x

 Web of Science ®Google Scholar

Canning S, Waterman M, Orsi N, Ayres J, Simpson N, Dye L. The efficacy of hypericum perforatum (st john’s wort) for the treatment of premenstrual syndrome: a randomized, double-blind, placebo-controlled trial. CNS Drugs. 2010;24(3):207–225. doi:10.2165/11530120-000000000-00000

 Web of Science ®Google Scholar

Ryoo JG, Chun S, Lee YJ, Suh HS. The effects of St. John’s wort on premenstrual syndrome in single women: a randomized double-blind, placebo-controlled study. Clin Psychopharmacol Neurosci. 2010;8(1):30–37.

 Google Scholar