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ISPMD Consensus on the Management of Premenstrual Disorders Arch Womens Ment Health DOI 10.1007/s00737-013-0346-y ORIGINAL ARTICLE ISPMD consensus on the management of premenstrual disorders Tracy Nevatte & Patrick Michael Shaughn O’Brien & Torbjorn Bäckström & Candace Brown & Lorraine Dennerstein & Jean Endicott & C. Neill Epperson & Elias Eriksson & Ellen W. Freeman & Uriel Halbreich & Khalid Ismail & Nicholas Panay & Teri Pearlstein & Andrea Rapkin & Robert Reid & David Rubinow & Peter Schmidt & Meir Steiner & John Studd & Inger Sundström-Poromaa & Kimberly Yonkers & Consensus Group of the International Society for Premenstrual Disorders Received: 7 November 2012 /Accepted: 22 March 2013 # Springer-Verlag Wien 2013 Abstract The second consensus meeting of the International psychiatrists, psychologists and pharmacologists each formally Society for Premenstrual Disorders (ISPMD) took place in presented the evidence within their area of expertise; this was London during March 2011. The primary goal was to evaluate followed by an in-depth discussion leading to consensus rec- the published evidence and consider the expert opinions of the ommendations. This article provides a comprehensive review ISPMD members to reach a consensus on advice for the of the outcomes from the meeting. The group discussed and management of premenstrual disorders. Gynaecologists, agreed that careful diagnosis based on the recommendations T. Nevatte (*) J. Endicott Institute for Science and Technology in Medicine, Department of Psychiatry, Columbia University, Keele University, Stoke on Trent, UK New York, NY, USA e-mail: [email protected] C. N. Epperson P. M. S. O’Brien Department of Psychiatry, Perelman School of Medicine Academic Unit of Obstetrics and Gynaecology, University at the University of Pennsylvania, Philadelphia, PA, USA Hospital North Staffordshire, Keele University School of Medicine, Stoke on Trent, Staffordshire, UK C. N. Epperson T. Bäckström Department of Obstetrics, Perelman School of Medicine Umea Neurosteroid Research Center, Department of Clinical at the University of Pennsylvania, Philadelphia, PA, USA Sciences, Norrland University Hospital, Umea, Sweden C. N. Epperson C. Brown Department of Gynecology, Perelman School of Medicine Department of Psychiatry, University of Tennessee Health Science at the University of Pennsylvania, Philadelphia, PA, USA Centre, Memphis, TN, USA E. Eriksson C. Brown Institute of Neuroscience and Physiology, Göteberg University, Department of Obstetrics, University of Tennessee Health Science Göteberg, Sweden Centre, Memphis, TN, USA C. Brown E. W. Freeman Department of Gynaecology, University of Tennessee Health Department of Obstetrics/Gynecology, University Science Centre, Memphis, TN, USA of Pennsylvania, Philadelphia, PA, USA L. Dennerstein E. W. Freeman Department of Psychiatry, University of Melbourne and National Department of Psychiatry, University of Pennsylvania, Ageing Research Institute, Melbourne, VIC, Australia Philadelphia, PA, USA T. Nevatte et al. and classification derived from the first ISPMD consensus home life. It is imperative to establish the correct diagnosis conference is essential and should underlie the appropriate using clearly defined criteria and to provide individualised, management strategy. Options for the management of premen- evidence-based treatment on the basis on the specific strual disorders fall under two broad categories, (a) those timing, severity and nature of symptoms, as well as on influencing central nervous activity, particularly the modulation patient preferences. of the neurotransmitter serotonin and (b) those that suppress ovulation. Psychotropic medication, such as selective serotonin Method reuptake inhibitors, probably acts by dampening the influence of sex steroids on the brain. Oral contraceptives, gonadotropin- Following the first International Society for Premenstrual releasing hormone agonists, danazol and estradiol all most Disorders (ISPMD) consensus meeting (O’Brien et al. likely function by ovulation suppression. The role of oopho- 2011), a second meeting was convened to discuss ways in rectomy was also considered in this respect. Alternative thera- which the premenstrual disorders may best be managed. The pies are also addressed, with, e.g. cognitive behavioural aim was to reach a consensus that would be published and therapy, calcium supplements and Vitex agnus castus easily accessible for health professionals across all disci- warranting further exploration. plines likely to encounter women presenting with premen- strual disorders. The group, consisting of international Keywords Premenstrual syndrome . Premenstrual experts in the fields of gynaecology, psychiatry, pharmacol- dysphoric disorder . Variant premenstrual disorder . Core ogy and practice nursing, met at the Royal College of premenstrual disorder . Premenstrual exacerbation . PMS . Obstetricians and Gynaecologists (RCOG), London in PMDD March 2011. Prior to the meeting, each expert was asked to prepare a presentation about their specific area of exper- tise regarding premenstrual disorders which included an Introduction evidence-based review of the literature and their own clin- ical experience of premenstrual disorder management. The definition, diagnosis and management of premenstrual Following each presentation, the group further discussed disorders (PMDs) have always been challenging. These that evidence and reached an agreement as to how to best conditions affect reproductive aged women and can have a manage premenstrual disorders using that particular treat- substantial impact on quality of life, with resultant impair- ment strategy. Subsequently, further discussions were un- ment of education/work, interpersonal relationships and dertaken by email in which the members of the previous U. Halbreich P. Schmidt State University of New York at Buffalo and WPA, Section on Behavioral Endocrinology, National Institute of Mental New York, NY, USA Health, Bethesda, MD, USA K. Ismail M. Steiner School of Clinical and Experimental Medicine, Department of Psychiatry, Behavioural Neurosciences, Birmingham Women’s Foundation Trust, College of Medical Obstetrics and Gynaecology, St Joseph’s Healthcare, and Dental Sciences, University of Birmingham, McMaster University, 301 James Street South, Edgbaston, Birmingham, UK Hamilton, ON L8P3B6, Canada N. Panay J. Studd Queen Charlotte’s and Chelsea and Westminster Hospitals, Department of Gynaecology, Chelsea and Westminster Hospital, Imperial College London, London, UK London, UK T. Pearlstein Department of Psychiatry and Human Behavior, I. Sundström-Poromaa Warren Alpert Medical School of Brown University, Department of Women’s and Children’s Health, Obstetrics Providence, RI, USA and Gynaecology, UU, 751 85 Uppsala, Sweden A. Rapkin K. Yonkers Department of Obstetrics and Genecology, David Geffen School of Department of Psychiatry, New Haven, CT, USA Medicine at University of California, Los Angeles, CA, USA R. Reid K. Yonkers Queen’s University, Kingston, ON, Canada Department of Obstetrics, New Haven, CT, USA D. Rubinow K. Yonkers University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Gynaecology, New Haven, CT, USA ISPMD consensus on the management of premenstrual disorders consensus meeting were invited to comment. As a result, (Endicott et al. 2006; Borenstein et al. 2007) is one easily this article is a comprehensive expert review of the evidence accessible, well-validated prospective rating scale that can presented with resulting recommendations for premenstrual be used to elucidate the pattern of symptoms. The minimum disorder management. The main treatment sections are pre- length of recording is two consecutive cycles; if there is a ceded by introductory sub-sections detailing the outcomes discrepancy between the two menstrual cycles a third cycle of the discussions at the London meeting with regards of rating should be carried out. Symptom recording can now diagnosis, epidemiology and underlying biology. be achieved online via mobile phone, iPAD, laptop or desk- top computer (Symptometrics, www.symptometrics.com) Classification and the DRSP can be downloaded from the internet (RCOG 2007, Green-top guideline no. 48). Before requesting Recently, the International Society for Premenstrual Disorders a patient to prospectively record her symptoms for at least two published a classification consensus that is outlined in Table 1 consecutive menstrual cycles, use of the premenstrual (O’Brien et al. 2011). screening tool may be of benefit (Steiner et al. 2003, 2011). Ovulation clearly underlies the pathogenesis of core pre- menstrual disorder with symptoms appearing during the Epidemiology luteal phase and resolving by the end of menstruation with a symptom-free interval in the follicular phase. There are A large number of population-based studies addressing the typical premenstrual symptoms but it is the timing rather prevalence of premenstrual complaints in Western countries than the nature of these symptoms that is important. A key has been undertaken (Woods et al. 1982; Andersch et al. 1986; factor for consideration is the impact of premenstrual symp- Johnson et al. 1988;Rivera-TovarandFrank,1990; toms upon a woman’s quality of life. The timing of symp- Ramacharan et al. 1992; Deuster et al. 1999; Sveindóttir and toms can be accurately recorded using prospective daily Bäckström 2000; Angst et al. 2001; Soares et al. 2001; Cohen records of symptom severity. et al. 2002a; Wittchen et al. 2002). Although these investiga- tions have applied different inventories,
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