Treatement
A) placebo surprisingly a very high response – B) lifestyle modifications and exercise are
first-line recommendations for all women with PMS/PMDD about 60% improvement C) SSRIs: SSRIs have been proven safe and
effective for the treatment of PMDD. The response rate is usually 60%-90% for
active treatment versus 30% -50% for placebo. They can be recommended as
first- line drugs if placebo does not work.. SSRIs are approved for PMDD in the
USA, Canada and Australia, but not in Europe.. SSRIs have been associated with
significant risks of major malformation, particularly cardiac defects, and
behaviour syndromes when used during pregnancy. Therefore, patients should be
advised of the reproductive safety of these medications and the importance of
balancing the risk versus the benefits on an individual agent if she at all
intend to achieve pregancy. D) The
synthetic androgen and gonadotropin inhibitor danazol, when administered at
doses that block ovulation, is effective for PMS but not an common drug of
choice.. E) cognitive behavioural therapy, if time permits for her.The aim of
cognitive behavioural therapy (CBT) is to improve coping strategies. A
systematic review has concluded that 'Low quality evidence from randomized
trials suggests that cognitive behavioural therapy may have important
beneficial effects in managing symptoms associated with premenstrual syndrome.
Even, herbal and vitamin
supplementation and complementary and alternative medicine have been evaluated
for use in PMS/PMDD, producing unclear or conflicting results. A wide variety
of products are used: oil of evening primrose, St John's Wort, chasteberry,
pollen, saffron and Chinese herbal medicines. More controlled clinical
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