Premenstrual Syndrome and Premenstrual Dysphoric Disorder: Quality of Life and Burden of Illness

Andrea J. Rapkin; Sharon A. Winer


Expert Rev Pharmacoeconomics Outcomes Res. 2009;9(2):157-170. 

In This Article

Expert Commentary and Five-year View

Expert Commentary

The burden of illness of the premenstrual disorders can be substantially reduced if clinicians take these symptoms seriously. Treating practitioners need to be aware that moderate-to-severe premenstrual symptoms are very prevalent and are not trivial. As recently as 2003, in a survey of British women who reported premenstrual symptoms, 14% indicated that medical professionals told them that their symptoms were "something they had to put up with and 11% felt that medical professionals lacked understanding".[61] PMS and PMDD have a significant impact not just on interpersonal relationships, but on daily activities and productivity in the home and workplace. In fact, some degree of impairment is explicit in the ACOG and DSM-IV diagnostic criteria for PMS and PMDD. Impairment and decreased HRQoL from PMS/PMDD is consistent with that from migraine headaches, depression, allergic disorders, and gastroesophogeal reflux disease and irritable bowel syndrome. PMS symptoms should be queried at the time of taking a medical history and to reduce the referral costs; obstetricians and gynecologists and general practitioners must be comfortable with prescribing SSRI and SNRI antidepressants and psychiatrists with OCs for this indication.

The economic burden associated with PMS/PMDD manifests itself primarily in reported productivity decrements but increased healthcare utilization and costs associated with work absenteeism have now been well established. Unfortunately, many policy makers and regulatory agencies seem to underestimate the significance of the disorders. Greater recognition worldwide of the affects of PMS and PMDD on the individual and on society should improve the likelihood of accurate diagnosis and treatment of the disorders. Improved measures of and quantification of the relative health and economic impact will also foster the development of better treatment modalities to decrease the burden of illness. Funding of research of the etiology and treatment of these disorders should match that for other medical and psychiatric diagnoses with similar prevalence, HRQoL and economic burden.

Five-year View

Ongoing research into etiology and treatment should help to decrease the HRQoL and burden of illness in this disorder. Areas of particular promise include genetic studies for vulnerability for premenstrual disorders, elucidation of cyclic changes in brain functioning in women with PMS using imaging with functional magnetic resonance and positron emission tomography, and novel pharmacologic agents involving ovulation suppression and modulation of the GABAergic system.


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