Views of Dutch general practitioners about premenstrual symptoms: A qualitative interview study

Abstract

Background General practitioners (GPs) encounter women suffering from premenstrual symptoms. Often women with premenstrual problems experience little understanding from GPs. Views of GPs will influence their approach to these women and their care. Insight into these views is lacking but could help in designing educational programmes for GPs. Objectives To explore the views of Dutch GPs towards aetiology, diagnostic process, and preferred treatment of premenstrual symptoms. Methods In 2017, we conducted a qualitative, semi-structured, interview survey among 27 GPs, varying in age, gender, and practice setting. Results Important themes emerged from the interviews: ‘no need for a symptom diary,’ ‘PMS defined as illness’ exclusively in case of disruption of normal functioning, and ‘symptomatic treatment’ as preferred approach. Most GPs considered PMS to be a physiological phenomenon, with taking history as an adequate diagnostic tool. Almost all GPs regarded a normal cyclical hormonal cycle as causal; many also mentioned the combination with personal sensitivity. Some pointed to a dividing line between physiological condition and illness if women could not function normally in daily life. Lastly, the approach GPs preferred was focussing on relieving symptoms of individual patients. In addition to explaining the hormonal cycle and lifestyle advice, all GPs advocated oral contraceptives, and if necessary psychological support. GPs expressed negative feelings about prescribing antidepressants. Conclusion GPs considered physiological changes and personal sensitivity as aetiological factors. We recommend more training to improve GPs knowledge and more insight into the burden of women with PMS. A symptom diary is an essential diagnostic tool for GPs.

Effect of Aerobic Exercises in Improving Premenstrual Symptoms Among Healthy Women: A Systematic Review of Randomized Controlled Trials

“…3 PMS occurs one week prior to the onset of menstruation in women of reproductive ages, declines with the onset of menstruation, and presents a set of physical and psychological symptoms, and the severity of which vary from one women to another. 4 Various researchers have found that diverse body systems such as cardiovascular, central nervous system, endocrine, and female reproductive system are associated with the symptoms of PMS, related to emotional, physical, cognitive, and behavioral aspects. 5 , 6 Epidemiological data shows that the symptoms are often mild in 75% of the women, but 3–8% reported to experience moderate to severe symptoms that are associated with substantial distress and functional impairment.…”

Perspectives of Dutch women on premenstrual disorder. A qualitative study exploring women’s experiences

“…The patients’ views and expectations contrast with the views of GPs, who consider PMD to be physiological in origin and primarily opt to give lifestyle advice and recommend women to accept symptoms [ 15 ]. Unawareness of the women’s perspectives or disregarding them may give rise to miscommunication in doctor-patient relationships.…”

“…The GP is also the gatekeeper to other primary and secondary healthcare professionals. Interviews with GPs in the Netherlands have revealed that, in general, they consider physiological hormonal changes and personal sensitivity as critical aetiological factors, preferring an approach of showing women how to deal with symptoms [ 15 ]. For GPs, it is vital to know what women experience as invalidating and troublesome for them to optimise care.…”

Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions: a systematic review

“…Medicalisation of social phenomena/not believing there to be a physical issue (n=7) (16,18,35,40,42,45,46) PCCs considered that symptoms associated with gynaecological conditions could arise due to psychological issues rather than physical issues, in particular, symptoms of endometriosis and chronic pelvic pain. (18,42,46) 4.4 Need to follow a diagnostic hierarchy (n=8) (16,17,27,35,37,39,42,45) PCCs seek to exclude the most serious conditions before considering less serious or time sensitive conditions.…”