Premenstrual Dysphoric Disorder Guidelines

Updated: Sep 15, 2021
  • Author: Thwe T Htay, MD, FACP; Chief Editor: Ana Hategan, MD, FRCPC  more...
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Guidelines Summary

Royal College of Obstetricians and Gynaecologists 

The Royal College of Obstetricians and Gynaecologists (RCOG) published guidelines showing that the first-line treatment for premenstrual dysphoric disorder (PMDD) include exercise, vitamin B6 (up to 100 mg daily), cognitive-behavioral therapy (CBT), oral contraceptives, and intermittent or continuous SSRIs for at least 1–2 months. For milder symtpoms or for women who choose to not use oral contraceptive or SSRI, a complex carbohydrate diet, exercise, and vitamin B6 (up to 100 mg daily) are recommended. For women who refuse pharmacological treatment, CBT is recommended. Women with moderate-to-severe symptoms or those who do not respond to above interventions should be placed on treatment with oral contraceptives or SSRIs. For women who do not respond to these interventions, treatment with a GnRH agonist should be considered. For women intolerant to hormonal treatments, and who have completed childbearing, surgical interventions such as as total hysterectomy with bilateral salpingo-oophorectomy can be considered to eliminate cyclical symptoms. [60]