Algorithm for the management of PMDD.pdf - Google Drive
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Algorithm for the management of PMDD.pdf - Google Drive
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Patient with suspected PMDD
Obtain history, conduct physical and mental status exam
Determine presence of a physical or psychiatric disorder as primary diagnosis (i.e. bipolar disorder, hormone imbalance, thyroid imbalance or disease, uterine and/or cervical inflammation)
Treat that disorder
Absence of a physical or comorbid psychiatric disorder and/or limited response to treatment of comorbid disorder
Confirm diagnosis using symptom checklist prospectively for two consecutive menstrual cycles and assess severity of symptoms
Mild to moderate severity and dysfunction (PMS)
Provide education and recommend lifestyle changes, nutritional, or non nutritional interventions
Severe symptoms and dysfunction (PMDD)
Limited response
Consider lifestyle changes and SSRI (preferably during luteal phase only)
Optimal response: Continue this approach Limited response Optimal response: Continue intermittent use of SSRI during luteal phase with lifestyle changes Consider cognitive-behavioral therapy (CBT) or luteal-phasespecific, low-dose alprazolam and/or symptom-focused therapy and lifestyle changes
Optimal response: Continue alprazolam intermittently and/or other therapies
Poor response
Consider GnRH agonist for two to three cycles
Optimal response: Discuss possibility of total hysterectomy with bilateral salpingo oophorectomy (THBSO) Algorithm for the management of Severe PMS/PMDD. (PMS = premenstrual syndrome; PMDD = premenstrual dysphoric disorder; SSRI = selective serotonin reuptake inhibitor; GnRH = gonadotropin-releasing hormone. Adapted from Am Fam Physician. 2002 Oct 1;66(7):1239-1249. rv 3/23/2017
