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RCOG release: Updated advice on the diagnosis and treatment of women with premenstrual syndrome (PMS)

News 30 November 2016

The timing of symptoms and degree of impact on daily activity determines a diagnosis of premenstrual syndrome (PMS), state revised guidelines for healthcare professionals published today by the Royal College of Obstetricians and Gynaecologists (RCOG).

Four in ten women experience symptoms of PMS and 5-8% of these will suffer severe PMS. The condition encompasses psychological symptoms such as depression, anxiety, irritability, loss of confidence and mood swings. Some women also experience physical symptoms such as bloating and breast pain.                      

A diagnosis of PMS can only be made if a woman or girl suffers symptoms at some point between days 14 – 28 of her menstrual cycle (luteal phase) and they are severe enough to impact on daily activity or interfere with work, school performance or relationships, state the guidelines. The symptoms should ease as soon as menstruation begins.

The guidelines highlight that in order to make a conclusive diagnosis of PMS, women must use a specifically designed symptom diary over the course of two menstrual cycles. If this is inconclusive, GnRH analogues, a medication which switches off ovarian production of estrogen, progesterone and testosterone, may need to be used for three months in order to rule out other psychiatric disorders.

Once a diagnosis has been made, women should be offered CBT routinely as a first line treatment option to PMS. Vitamin B6 and exercise have also been shown to ease symptoms.

Continuous use of the contraceptive pill (one of the more recently developed combined pills) or an SSRI should be offered as first line pharmaceutical treatment. Other treatment options include estrogen patches or an implant, selective serotonin reuptake inhibitors (SSRIs) and GnRH analogues. Surgery should normally be a last resort and both the ovaries and womb should be removed to ensure that symptoms are permanently removed. Whilst this is an invasive procedure, it is the only permanent cure for PMS.

The guidelines state that currently there is little evidence to support the use of complementary medicines as a treatment option for PMS, and some may interact with other medications.

Shaughn O’Brien, Professor of Obstetrics and Gynaecology at Keele University and lead author of the guidelines, said:

 “PMS can be a serious condition which can dramatically impact on the quality of a woman’s life affecting her personal and professional life, therefore it is essential that an integrated holistic approach to treatment is adopted. Whilst many women can be treated by their GP by adopting lifestyle changes, taking the contraceptive pill, SSRIs or vitamin B6, some women will need more complex care provided by a team of GPs, gynaecologists, psychiatrists and dieticians. In the most extreme cases, PMS can lead to self-harm and suicide.

“We hope that these guidelines go some way in raising awareness of the seriousness of the condition and available treatment options, not only in women but also among healthcare professionals.”


For media enquiries and copies of the guidelines, please contact the RCOG press office on 020 7772 6444 or email

This is the second edition of these guidelines, which were first published in 2007.

The guidelines adopt the International Society for Premenstrual Disorders (ISPMD)’s International Consensus on Diagnosis and Classification.