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]

Medication

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Author

Thwe T Htay, MD, FACP Associate Professor of Medicine, Medical Skills Course Director, Department of Medical Education, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Thwe T Htay, MD, FACP is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Amy HoangAnh Doan, MD Resident Physician, Department of Pediatrics, University of Texas Health Science Center at Houston, McGovern Medical School

Amy HoangAnh Doan, MD is a member of the following medical societies: American Medical Association, National Med-Peds Residents' Association, Texas Medical Association

Disclosure: Nothing to disclose.

KoKo Aung, MD, MPH, FACP Professor of Internal Medicine and Associate Academic Dean, Vice President, Texas Tech University Health Sciences Center at El Paso, Paul L Foster School of Medicine

KoKo Aung, MD, MPH, FACP is a member of the following medical societies: American College of Physicians, Society of General Internal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Ana Hategan, MD, FRCPC Associate Clinical Professor, Department of Psychiatry and Behavioral Neurosciences, Division of Geriatric Psychiatry, McMaster University School of Medicine; Geriatric Psychiatrist, St Joseph's Health Care Hamilton, Canada

Ana Hategan, MD, FRCPC is a member of the following medical societies: Canadian Academy of Geriatric Psychiatry, Canadian Coalition for Seniors' Mental Health, Canadian Psychiatric Association, International Psychogeriatric Association, Ontario Medical Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Book royalties and/or honoraria for articles from American Psychiatric Publishing, Springer, and Current Psychiatry.

Acknowledgements

Ronald C Albucher, MD Chief Medical Officer, Westside Community Services; Consulting Staff, California Pacific Medical Center

Ronald C Albucher, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

John Carrick, MD Consulting Staff, Department of Psychiatry, Flagstaff Medical Center

John Carrick, MD is a member of the following medical societies: American Association for Geriatric Psychiatry

Disclosure: Nothing to disclose.

Romeo Papica II MD Staff Physician, Premier Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Sections Premenstrual Dysphoric Disorder
Overview
Presentation
DDx
Workup
Treatment
Guidelines
Medication
References

Premenstrual Dysphoric Disorder Guidelines

Guidelines Summary

Royal College of Obstetricians and Gynaecologists

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