Pharmacologic treatment of PMS and PMDD

PMS: premenstrual syndrome; PMDD: premenstrual dysphoric disorder; COC: combined oral contraceptive; SSRI: selective serotonin reuptake inhibitor; GnRH: gonadotropin-releasing hormone.
* Symptoms are charted prospectively using a Daily Record of Severity of Problems (DRSP) form to confirm the diagnosis of PMDD.
¶ For women who desire hormonal contraception, we start with a COC; usually one containing 20 mcg of ethinyl estradiol with 3 mg of drospirenone. A COC administered continuously is a second option.
Δ For women with documented PMDD who do not want hormonal contraception, we suggest an SSRI, which can be given continuously, during the luteal phase only, or as a "symptom-onset" regimen. We typically start with citalopram or escitalopram. We suggest a 2- to 3-month trial, typically starting at a low dose and titrating up to an optimal dose; switching from an intermittent to continuous regimen if needed, and trying a second SSRI if the first does not provide adequate symptom relief.
◊ Many women with PMDD require therapy until menopause except when pursuing pregnancy.