ISPMD consensus on the management of premenstrual disorders

Abstract

The second consensus meeting of the International Society for Premenstrual Disorders (ISPMD) took place in London during March 2011. The primary goal was to evaluate the published evidence and consider the expert opinions of the ISPMD members to reach a consensus on advice for the management of premenstrual disorders. Gynaecologists, psychiatrists, psychologists and pharmacologists each formally presented the evidence within their area of expertise; this was followed by an in-depth discussion leading to consensus recommendations. This article provides a comprehensive review of the outcomes from the meeting. The group discussed and agreed that careful diagnosis based on the recommendations and classification derived from the first ISPMD consensus conference is essential and should underlie the appropriate management strategy. Options for the management of premenstrual disorders fall under two broad categories, (a) those influencing central nervous activity, particularly the modulation of the neurotransmitter serotonin and (b) those that suppress ovulation. Psychotropic medication, such as selective serotonin reuptake inhibitors, probably acts by dampening the influence of sex steroids on the brain. Oral contraceptives, gonadotropin-releasing hormone agonists, danazol and estradiol all most likely function by ovulation suppression. The role of oophorectomy was also considered in this respect. Alternative therapies are also addressed, with, e.g. cognitive behavioural therapy, calcium supplements and Vitex agnus castus warranting further exploration.

Treating comorbid premenstrual dysphoric disorder in women with bipolar disorder

“…7. Hormonal agents are considered the second-line treatment for PMDD, 13 and their efficacy has also been confirmed in randomized controlled trials. 15 Although the literature on safety and efficacy of hormonal agents in women with comorbid BD is scarce, we have recently published a case series discussing some of our experience with the use of oral or transdermal contraceptives in this population.…”

“…6. Antidepressants are considered the first-line treatment of PMDD, 13 as there is robust evidence of efficacy of serotonin and serotoninnorepinephrine reuptake inhibitors in randomized controlled trials. 14 However, this is precisely one of the main challenges in the treatment of PMDD with comorbid BD because, considering the wellestablished risk for mood worsening associated with the use of antidepressants in patients with BD, experienced clin icians will be very reluctant to prescribe an antidepressant to a patient with BD who is currently euthymic/stable from the BD standpoint.…”

Interdisciplinary consensus on management of premenstrual disorders in Switzerland

“…The International Society for Premenstrual Disorders (ISPD) has published and updated a consensus paper on premenstrual disorders (PMD) [1][2][3][4]. Accordingly, a core PMD can be distinguished from variants of PMDs (Table 1).…”

“…Since PMS and PMDD symptoms are unspecific and overlap with those of various other conditions, a valid and reliable prospective symptom inventory is required to confirm the diagnosis [3]. In particular, PMDD is frequently associated with psychiatric comobidities such as depression (23%), bipolar disorder (8%) and anxiety (7%) [8], and thus, it is important to ask the patient about any known underlying psychiatric disorders and suicidal ideation.…”

“…In addition, current mood situation is assessed by a visual analog scale (scale 0-10) consisting of four items. Regardless of the questionnaire applied, the minimum length of recording should be two consecutive cycles [3]. The unsolved issue of all questionnaires is that there are no cutoff values that define PMS.…”