Fourth consensus of the International Society for Premenstrual Disorders (ISPMD): auditable standards for diagnosis and management of premenstrual disorder

Abstract

Whilst professional bodies such as the Royal College and the American College of Obstetricians and Gynecologists have well-established standards for audit of management for most gynaecology disorders, such standards for premenstrual disorders (PMDs) have yet to be developed. The International Society of Premenstrual Disorders (ISPMD) has already published three consensus papers on PMDs covering areas that include definition, classification/quantification, clinical trial design and management (American College Obstetricians and Gynecologists 2011; Brown et al. in Cochrane Database Syst Rev 2:CD001396, 2009; Dickerson et al. in Am Fam Physician 67(8):1743-1752, 2003). In this fourth consensus of ISPMD, we aim to create a set of auditable standards for the clinical management of PMDs. All members of the original ISPMD consensus group were invited to submit one or more auditable standards to be eligible in the inclusion of the consensus. Ninety-five percent of members (18/19) responded with at least one auditable standard. A total of 66 auditable standards were received, which were returned to all group members who then ranked the standards in order of priority, before the results were collated. Proposed standards related to the diagnosis of PMDs identified the importance of obtaining an accurate history, that a symptom diary should be kept for 2 months prior to diagnosis and that symptom reporting demonstrates symptoms in the premenstrual phase of the menstrual cycle and relieved by menstruation. Regarding treatment, the most important standards were the use of selective serotonin reuptake inhibitors (SSRIs) as a first line treatment, an evidence-based approach to treatment and that SSRI side effects are properly explained to patients. A set of comprehensive standards to be used in the diagnosis and treatment of PMD has been established, for which PMD management can be audited against for standardised and improved care.

Anxiety Disorders Among Women: A Female Lifespan Approach

“…As many as 80% of reproductive aged women experience at least one physical, mood, or anxiety symptom in the luteal phase (13–16). Approximately 20% experience significant premenstrual symptoms (13; 14; 16).…”

Making Strides to Simplify Diagnosis of Premenstrual Dysphoric Disorder

“…This constellation of symptoms must have occurred in most menstrual cycles in the previous year and must be confirmed with at least two cycles of prospective daily ratings. Symptoms must result in clinically meaningful distress or impairment, cannot represent a mere exacerbation of symptoms of another disorder, and cannot be induced by the use of steroid contraceptives (3, 4). While inclusion of PMDD as a full disorder in DSM-5 was certainly a major step forward for women who suffer from it, further efforts are needed to systematize the application of the disorder’s diagnostic criteria in clinical and research settings (5).…”

“…This latter group may have another menstrually related mood disorder (MRMD), such as premenstrual worsening of an affective disorder or subthreshold PMDD (3), and be as distressed or impaired as someone with full-criteria PMDD (6). However, inclusion of these individuals in research focusing on the pathophysiology and treatment of PMDD hinders scientific advancement.…”

Interdisciplinary consensus on management of premenstrual disorders in Switzerland

“…The International Society for Premenstrual Disorders (ISPD) has published and updated a consensus paper on premenstrual disorders (PMD) [1][2][3][4]. Accordingly, a core PMD can be distinguished from variants of PMDs (Table 1).…”

“…In nonresponders or pretreated women, second-line treatment comprises either a 2-month course of COC (if contraception is needed and VTE risks are absent) or antidepressants (SSRI, SNRI) (if no contraception is needed or VTE risks are present) at different dosages and regimens. Patients who start on SSRIs should be offered a follow-up appointment (face to face or phone) 1 week after treatment start in order to assess for increased anxiety [4]. In women seeking to become pregnant, citalopram and sertraline are the preferred SSRI.…”