DOI: 10.1001/jama.2025.26054
First author: Rebeca Ortiz Worthington
Journal: JAMA
Month, year: February 2026
Synopsis
This JAMA Clinical Guidelines Synopsis summarizes the 2023 ACOG Clinical Practice Guideline on the management of premenstrual disorders, including premenstrual syndrome and premenstrual dysphoric disorder. Premenstrual disorders are defined as cyclic affective and physical symptoms occurring in the luteal phase and resolving with or shortly after menstruation, with diagnosis requiring prospective daily symptom tracking. The guideline emphasizes that selective serotonin reuptake inhibitors are effective for affective symptoms, with strong recommendations supported by moderate quality evidence. Combined oral contraceptives, particularly those containing drospirenone, are also recommended, although the quality of evidence is lower. Cognitive behavioral therapy is endorsed as an effective nonpharmacologic option. Overall, most recommendations are based on low-quality evidence, highlighting gaps in comparative effectiveness data and long-term outcomes.
