Pharmacological management of premenstrual disorder

Over the last decade there has been increasing recognition of premenstrual disorders, and numerous treatments have been tried for symptom relief. A literature search using Medline was conducted to locate all articles written in English and including the terms "premenstrual treatment," "premenstrual syndrome," "late luteal phase dysphoric disorder," or "menstruation and mood" over the last 30 years. Although more than 300 articles were retrieved, only one-third of them described double-blind studies and just 41 of the double-blind studies involved prospective diagnosed patients. The definition of the disorder varied across studies, as did research design and outcome measures. Many studies did not assess for Axis I comorbidity, which may have a significant impact on drug response. We attempted to do a metaanalysis of the existing double-blind, prospectively diagnosed studies, broken down by drug class and symptom reduction. However, we could not make statistical comparisons within or across drug groups to assess efficacy of treatment for specific symptoms due to differences in outcome-assessment measures across studies. Several promising pharmacological strategies exist to treat the patient with premenstrual dysphoric disorder. We review double-blind studies for each class of drugs, highlight some open studies, and present guidelines. Additional double-blind studies with prospectively diagnosed patients are needed. Standardization of definition, design, and outcome measures used in this field is important to enable direct comparison across studies of different treatment strategies.