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Premenstrual Syndrome, Management (Green-top Guideline No. 48)


Since the first edition, there has been considerable work by the International Society for Premenstrual Disorders and the National Association for Premenstrual Syndrome to achieve consensus on the recognition, diagnosis, classification and management of premenstrual syndrome (PMS). 

Misdiagnosis of PMS (e.g. confusion with bipolar disorder) and the use of a wide range of treatments, often with little evidence for effectiveness and safety, demand that these issues are addressed.

PMS encompasses a vast array of psychological symptoms such as depression, anxiety, irritability, loss of confidence and mood swings. There are also physical symptoms, typically bloatedness and mastalgia. Four in ten women (40%) experience symptoms of PMS and of these 5–8% suffer from severe PMS.

The aim of this guideline is to review the diagnosis, classification and management of PMS. In addition, the evidence for pharmacological and nonpharmacological treatments is examined.

COVID disclaimer

This guideline was developed as part of the regular programme of Green-top Guidelines, as outlined in our document Developing a Green-top Guideline: Guidance for developers (PDF), and prior to the emergence of COVID-19.

Version history

This is the second edition of this guideline.

Please note that the RCOG Guidelines Committee regularly assesses the need to update the information provided in this publication. Further information on this review is available on request.

Developer declaration of interests

Dr LJ Green: None declared.

Professor PMS O’Brien: Professor O’Brien has received consultancy fees, payments for lectures and expenses, as well as longstanding support for research from Bayer Healthcare. He has also received payment for consultancy work from Umercrine Mood Pharma Sweden (now renamed Asarina Pharma). He has copyright protection for the Menstrual Pictogram and its various guises; a commercial interest jointly between Keele University and Bayer Healthcare. Professor O’Brien is currently receiving EU Research Funding from the EU Framework 7 Programme, from the National Institute for Health Research and from North Staffordshire Medical Institute; some of which relates to menstrual disorders and specifically PMS. He is Chairman of the International Society for Premenstrual Disorders, Past Chairman of the British Society for Psychosomatic Obstetrics and Gynaecology and Andrology and recent Editor-in-Chief of the Journal of Psychosomatic Obstetrics and Gynaecology. He is Senior Editor of three current textbooks: one for Informa Press (The Premenstrual Disorders) and two for Cambridge University Press (CUP) (Biopsychosocial Factors in Obstetrics and Gynaecology and Introduction to Research Methodology). He receives and has received limited royalties from Informa Press, Royal College of Obstetricians and Gynaecologists (RCOG) Press and CUP. Professor O’Brien is co-inventor of PreMentricS app which is used to quantify premenstrual syndrome and is distributed through the iTunes App Store, and a member of his immediate family devised and manages the website for the app. The same family member has undertaken research on ovarian, breast and prostate cancers as a senior employee of Astra Zeneca, and has shares in that company.

Mr N Panay: Mr Panay has received sponsorship or paid consultancy work from Abbott, Bayer, Besins, Meda, MSD, Mylan, Novo Nordisk, Pfizer and Shionogi. He is Past Chairman of the British Menopause Society, Chairman of the National Association for Premenstrual Syndrome (NAPS), Past President of the Royal Society of Medicine (Obstetrics and Gynaecology section), Patron of Daisy Network (Premature Ovarian Insufficiency Society) and Honorary Director of Conferences at the RCOG. He is currently the Co Editor-in-Chief of Climacteric (The Journal of the International Menopause Society) and is on the editorial advisory board for the Journal of Family Planning and Reproductive Healthcare.

Dr M Craig: Dr Craig is the present Chair of the UK and Ireland Marcé Society (UKIMS) for Perinatal Mental Health and Trustee and medical advisor to NAPS. He is also Clinical Lead of the National Female Hormone Clinic at the Maudsley Hospital, London. This national multiprofessional treatment service accepts NHS and private patient referrals from across the UK.

This page was last reviewed 01 December 2016.