Intended for healthcare professionals

Clinical Review

Diagnosis and management of premenstrual disorders

BMJ 2011; 342 doi: (Published 03 June 2011) Cite this as: BMJ 2011;342:d2994
  1. Shaughn O’Brien, professor of academic obstetrics and gynaecology1,
  2. Andrea Rapkin, professor of obstetrics and gynaecology2,
  3. Lorraine Dennerstein, professorial fellow3,
  4. Tracy Nevatte, postdoctoral research associate4
  1. 1Keele University and University Hospital of North Staffordshire, Staffordshire, UK
  2. 2David Geffen School of Medicine at UCLA, Department of Obstetrics and Gynecology, Box 951740, Los Angeles, CA, USA
  3. 3National Aging Research Institute, Department of Psychiatry, University of Melbourne, Vic, Australia
  4. 4Keele University, Institute of Science and Technology in Medicine, Guy-Hilton Research Centre, Stoke on Trent, Staffordshire ST4 7QB, UK
  1. Correspondence to: T Nevatte t.nevatte{at}

Summary points

  • Premenstrual disorders can considerably impair functioning at work or school and affect interpersonal relationships

  • The cause of premenstrual disorders is not understood but symptoms are clearly related to ovulation

  • Precise diagnosis and classification are key to successful treatment of most patients

  • Severity of symptoms, pregnancy and contraceptive needs, and the patient’s wishes will dictate the invasiveness of treatment

  • Patients may be treated effectively using non-drug based interventions, suppression of ovulation, or specific psychotropics, often in general practice

  • Given the disorder’s complexity, a tailored empirical approach, based on evidence and good clinical judgment, is preferable

Premenstrual disorders have a substantial social, occupational, academic, and psychological effect on the lives of millions of women (from menarche to menopause) and their families.1 Published criteria for diagnosis vary greatly between authoritative bodies, so the true prevalence rates are unknown. A new classification from the International Society for Premenstrual Disorders (ISPMD) will allow this to be resolved.2 It will also enable clinicians to provide accurate diagnosis and effective management.2 Little is known about what causes premenstrual syndromes, and the few treatments that are licensed are ineffective,3 4 5 although treatment can, however, be provided for most women with good effect using unlicensed approaches. In this article, we discuss the classification of premenstrual disorders, how to measure symptoms and diagnose the condition, and effective management strategies. This review is based on evidence from randomised placebo controlled trials where available, recent Cochrane reviews, Royal College of Obstetricians and Gynaecologists’ evidence based guidelines and published consensus statements and textbooks by internationally recognised experts.

Sources and selection criteria

We searched Medline, PubMed, evidence based specialty guidelines, and Cochrane reviews. In addition, we used the recently published consensus of the International Society for Premenstrual Disorders and a comprehensive textbook by globally recognised experts that reviewed the entire literature on premenstrual …

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