Management of Severe Premenstrual Syndrome (PMS)/Premenstrual Dysphoric Disorder (PMDD)

Universal adoption of the International Society of Premenstrual Disorders diagnostic criteria is vital to facilitate recognition and treatment of severe premenstrual syndrome (PMS)/premenstrual dysphoric disorder (PMDD). In a landmark decision in May 2019, the World Health Organization (WHO) added premenstrual dysphoric disorder to the International Statistical Classification of Diseases, Eleventh Revision (ICD-11). PMDD now has its own ICD code (GA34). Training of health professionals should be urgently addressed by universities, royal colleges, and other academic institutions. Management of severe PMS/PMDD should be by multidisciplinary teams with reference to evidence-based guidelines. The best evidence thus far is for 24/4 or continuous combined oral contraceptives, transdermal estradiol with progesterone/progestogens, selective serotonin and noradrenaline reuptake inhibitors, gonadotropin-releasing hormone agonists, and hysterectomy with bilateral oophorectomy with adequate hormone therapy.