7.1.6 Premenstrual tension syndrome

ChoiceDrugDosage
1st choice No drug treatmentsee prescribing notes
2nd choiceNew generation COC e.g. Gedarel® 30/50 (desogestrel 150 micrograms, ethinylestradiol 30 micrograms) (3 x 21 pack)
- consider for moderate premenstrual syndrome

See section 7.3.1
(off label use if used solely to treat PMS)

Fluoxetine 20mg capsules; liquid 20mg/5ml (for severe premenstrual syndrome) Dose [unlicensed use]:
20mg daily from days 14 - 28 for 3 months, then reassess benefit before continuing

Prescribing Notes

  • For more information refer to CKS guidance on premenstrual syndrome.
  • Hormonal manipulation may be useful, e.g. a new generation combined oral contraceptive, in some circumstances.
  • The COC can be used cyclically or continuously for premenstrual syndrome.
  • Fluoxetine is no longer licensed for the treatment of premenstrual tension but there is some evidence to support its use; informed consent should be obtained and documented.