Towards a consensus on diagnostic criteria, measurement and trial design of the premenstrual disorders: the ISPMD Montreal consensus

Abstract

Premenstrual disorders (PMD) are characterised by a cluster of somatic and psychological symptoms of varying severity that occur during the luteal phase of the menstrual cycle and resolve during menses (Freeman and Sondheimer, Prim Care Companion J Clin Psychiatry 5:30–39, 2003; Halbreich, Gynecol Endocrinol 19:320–334, 2004). Although PMD have been widely recognised for many decades, their precise cause is still unknown and there are no definitive, universally accepted diagnostic criteria. To consider this issue, an international multidisciplinary group of experts met at a face-to-face consensus meeting to review current definitions and diagnostic criteria for PMD. This was followed by extensive correspondence. The consensus group formally became established as the International Society for Premenstrual Disorders (ISPMD). The inaugural meeting of the ISPMD was held in Montreal in September 2008. The primary aim was to provide a unified approach for the diagnostic criteria of PMD, their quantification and guidelines on clinical trial design. This report summarises their recommendations. It is hoped that the criteria proposed here will inform discussions of the next edition of the World Health Organisation's International Classification of Diseases (ICD-11), and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) criteria that are currently under consideration. It is also hoped that the proposed definitions and guidelines could be used by all clinicians and investigators to provide a consistent approach to the diagnosis and treatment of PMD and to aid scientific and clinical research in this field.

Association of Premenstrual Syndrome with Blood Pressure in Young Adult Women

“…We assessed menstrual symptom occurrence via a retrospective questionnaire rather than with prospective symptom diaries, which are recommended for clinical studies of PMS. 8 However, our method has high sensitivity, specificity, and positive predictive value when validated against prospective methods. 13 In addition, because completion of a single questionnaire places lower burden on study participants than completion of multiple cycles of daily diaries, studies using a single questionnaire are less subject to selection bias and power issues related to differential dropout.…”

“…7,8 Multiple mechanisms contributing to PMS have also been implicated in hypertension, such as renin-angiotensin-aldosterone system (RAAS) dysfunction and micronutrient deficiencies. [9][10][11][12] Thus, PMS may potentially be associated with higher blood pressure and future risk of hypertension.…”

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).…”

“…Psychotropic agents comprise antidepressants and anxiolytics (Table 6) [1,2,3,15,22]. Antidepressants can be applied continuously or during the luteal phase only (start: 14 days before the expected onset of menstrual bleeding; stop: onset of menstrual bleeding or a few days later).…”

“…Neither progestins nor progesterone have been proven to be effective in women suffering from PMD and are therefore not generally recommended [1,2,22,27,36]. However, the most recent Cochrane review stated that the (heterogeneous) trials included did not show that progesterone was not an effective treatment for PMS [37].…”