Premenstrual syndrome

Premenstrual symptoms occur in 95% of women of reproductive age. Severe, debilitating symptoms (PMS) occur in about 5% of those women. There is no consensus on how symptom severity should be assessed, which has led to a wide variety of symptoms scales, making it difficult to synthesise data on treatment efficacy. The cyclical nature of the condition also makes it difficult to conduct RCTs.

We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments; hormonal treatments; psychological interventions; physical therapies; dietary supplements; and surgical treatments in women with premenstrual syndrome? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

We found 52 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupuncture, alprazolam, bright light therapy, buspirone, chiropractic manipulation, clomipramine, cognitive behavioural therapy, danazol, endometrial ablation, evening primrose oil, exercise, gonadorelin analogues, hysterectomy, laparoscopic bilateral oophorectomy, magnesium supplements, metolazone, non-steroidal anti-inflammatory drugs, oestrogens, oral contraceptives, progesterone, progestogens, pyridoxine, reflexology, relaxation, selective serotonin reuptake inhibitors, spironolactone, tibolone.