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Cognitive Behavioral Therapy for Premenstrual Syndromes: A Review of the Literature

Significant numbers of reproductive-aged women experience premenstrual syndromes characterized by depressed mood, irritability, mood swings, anxiety or tension, sleep disruption, and other physical symptoms, including bloating and breast tenderness. Typically these symptoms emerge during the week preceding menstruation, improve with the onset of menses, and are not present during the week after menstruation.

When a woman experiences at least five symptoms that cause significant disruption in daily functioning (including work, social, or relationship functioning), she may be diagnosed with Premenstrual Dysphoric Disorder (PMDD). PMDD affects approximately 3-8% of reproductive aged women.

In a recent paper published in the Archives of Women’s Mental Health, Lustyk and colleagues review the evidence in support of using Cognitive Behavioral Therapy (CBT) to treat premenstrual syndromes. CBT is a short-term, skills focused form of talk therapy that focuses on the interaction between thoughts, feelings, and behaviors. A core tenet of CBT is that an individual’s perception of an event can affect the way in which he or she experiences that event, including physical sensations.

CBT has been shown to be an effective treatment for mood and anxiety disorders and has been shown to help people cope better with physical symptoms, such as pain. Lustyk and colleagues highlight the fact that premenstrual syndromes have similar symptom patterns as the mood and anxiety disorders for which CBT has been shown to be an effective treatment.

In this paper, Lustyk and colleagues identified seven published studies evaluating the efficacy of CBT for the treatment of various premenstrual syndromes. While most studies showed an improvement in symptoms among participants receiving CBT, these changes were not always statistically significant and the degree of reduction in symptoms experienced by participants receiving CBT were not always greater than observed in participants receiving another treatment (such as medication or lifestyle modification, including relaxation or making dietary changes).

While it seems that teaching women cognitive strategies to manage the symptoms of their premenstrual syndromes did not consistently result in a significant improvement in symptoms, the authors note several flaws in the design of the studies they reviewed. Most of these studies lacked a control group and/or random assignment to groups and tested CBT on only small numbers of women. Furthermore, the specific interventions used in the CBT treatments in the individual studies were not always well defined, making the quality of the interventions difficult to evaluate.

Due to the limitations of existing research, the use of CBT as a treatment for premenstrual symptoms requires further study before drawing conclusions about its effectiveness as a treatment. CBT should also be evaluated as an adjunct therapy to medication and lifestyle modification. In the interim, women should review the data on efficacy, safety, and side effects of treatments with their physicians when making decisions related to the treatment of premenstrual syndromes.

Christina Psaros, PhD

Lustyk MKB, Gerrish WG, Shaver S, Keys SL. Cognitive behavioral therapy for premenstrual syndrome and premenstrual dysphoric disorder: A systematic review. Arch Womens Ment Healh. 2009. February; v(i): pgs.

To read more about premenstrual syndromes and PMDD:

Cohen LS, Soares CN, Otto MW, Sweeney BH, Liberman RF, Harlow BH. Prevalence and predictors of premenstrual dysphoric disorder (PMDD) in older premenopausal women: The Harvard Study of Moods and Cycles. J Affect Disord. 2002. July; 70(2): 125-32.

Freeman EW. Premenstrual syndrome and premenstrual dyshphoric disorder: definitions and diagnosis. Psychoneuroendocrinology. 2003. August; 28(Suppl 3): 25-37.

Halbreich U, Borenstein J, Pearlstein T, Kahn LS. The prevalence, impairment, and burden of premenstrual dysphoric disorder (PMS/PMDD). Psychoneuroendocrinology. 2003. August; 28(Suppl 3): 1-23.

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One Response to Cognitive Behavioral Therapy for Premenstrual Syndromes: A Review of the Literature

  1. Ian October 23, 2010 at 3:11 pm #

    I found this article very interesting. I am a therapist and counsellor working in Manchester, UK but I’m not a specialist in CBT. I feel much more eager to learn about how I can use CBT in my own practice now

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