Condition

Premenstrual Syndrome

PMS - Physical and emotional symptoms before menstruation

1.9B
People Affected
100
Active Trials
19M
New Cases/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Fluoxetine (SSRI)
80% Effectiveness• 90% Confidence• 60% Safety• 50 trials• 10K participants
HIGH EvidenceGood ValueDose: 10-20mg daily
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Comparative Safety Scale(Higher is safer)

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60
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

Continuous or luteal phase

Response Rate

70%

Remission Rate

40%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

10

Common Side Effects:

Nausea: 20%
Insomnia: 15%
Sexual dysfunction: 30%
Headache: 10%

Annual Cost of Care

Drug Cost

$75

Monitoring

$100

Side Effects

$50

Total Annual

$225

Cost-Effectiveness

GOOD

QALYs Gained

0.1

ICER

$45,000/QALY

Cost per Remission

$563

Cost per Responder

$321

Treatment Outcomes
Efficacy Outcomes
Overall Effectiveness
+80%
Response Rate
+70%
Remission Rate
+40%
Common Side Effects
Nausea
+20%
Insomnia
+15%
Sexual dysfunction
+30%

Clinical Trial Phases:

Phase 4
2
Sertraline (SSRI)
78% Effectiveness• 88% Confidence• 60% Safety• 1 trials• 9K participants
HIGH EvidenceGood ValueDose: 25-50mg daily
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Comparative Safety Scale(Higher is safer)

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60
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

Continuous or luteal phase

Response Rate

68%

Remission Rate

38%

Number Needed to Treat (NNT)

4

Number Needed to Harm (NNH)

9

Common Side Effects:

Nausea: 25%
Diarrhea: 18%
Sexual dysfunction: 35%
Insomnia: 12%

Annual Cost of Care

Drug Cost

$80

Monitoring

$100

Side Effects

$55

Total Annual

$235

Cost-Effectiveness

GOOD

QALYs Gained

0.09

ICER

$48,000/QALY

Cost per Remission

$618

Cost per Responder

$346

Treatment Outcomes
Primary Outcomes
DRSP Total Score (Emotional and Physical Symptoms)DRSP Total Score: 85/126 points
-40% (-34 points)
DRSP Emotional/Behavioral Subscale ScoreDRSP Emotional/Behavioral Subscale Score: 50/66 points
-45% (-22.5 points)
DRSP Physical Subscale ScoreDRSP Physical Subscale Score: 35/60 points
-25% (-8.75 points)
Clinical Global Impression - Severity (CGI-S) ScoreCGI-S Score: 4.5/7 points (moderately ill)
-33.3% (-1.5 points)
Secondary Benefits
SF-36 Mental Component Summary (MCS) ScoreSF-36 MCS Score: 35/100 points
+20% (+7 points)
Sheehan Disability Scale (SDS) Total ScoreSDS Total Score: 18/30 points
-30% (-5.4 points)
DRSP Irritability/Anger Item ScoreDRSP Irritability/Anger Item Score: 4.5/6 points
-50% (-2.25 points)
Common Side Effects
Nausea
+25%
Diarrhea
+18%
Sexual dysfunction
+35%

Clinical Trial Phases:

Phase 4
3
Combined Oral Contraceptives (Drospirenone/Ethinyl Estradiol)
70% Effectiveness• 85% Confidence• 60% Safety• 8 trials• 8K participants
HIGH EvidenceModerate ValueDose: One pill daily
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Comparative Safety Scale(Higher is safer)

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Meth💀
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60
DangerousModerateSafe

Time to Effect

1-3 cycles

Duration

Continuous

Response Rate

60%

Remission Rate

30%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

1000

Common Side Effects:

Nausea: 15%
Breast tenderness: 20%
Headache: 10%
Venous Thromboembolism (rare): 0.1%

Annual Cost of Care

Drug Cost

$450

Monitoring

$150

Side Effects

$100

Total Annual

$700

Cost-Effectiveness

MODERATE

QALYs Gained

0.07

ICER

$95,000/QALY

Cost per Remission

$2,333

Cost per Responder

$1,167

Treatment Outcomes
Primary Outcomes
Daily Record of Severity of Problems (DRSP) Total ScoreDRSP Total Score: 32/60
-50% (-16 points)
Irritability/Anger Severity Score (Daily Rating)3/4 (severe)
-60% (-1.8 points)
Depressed Mood Severity Score (Daily Rating)3/4 (severe)
-55% (-1.7 points)
Physical Symptoms Cluster Score (e.g., Bloating, Breast Tenderness) (Daily Rating)8/12
-40% (-3.2 points)
Secondary Benefits
Premenstrual Syndrome Quality of Life (PMQoL) ScorePMQoL Score: 50/100 (lower score = worse QoL)
+25% (+12.5 points)
Social Activity Impairment Score (Daily Rating)3/4 (severe interference)
-55% (-1.7 points)
Headache Severity/Frequency Score (Daily Rating)2/4 (moderate)
-30% (-0.6 points)
Common Side Effects
Nausea
+15%
Breast tenderness
+20%
Headache
+10%

Clinical Trial Phases:

Phase 4
4
Cognitive Behavioral Therapy (CBT)
65% Effectiveness• 80% Confidence• 95% Safety• 5 trials• 3K participants
MODERATE EvidenceGood ValueDose: 1-2 hour sessions weekly
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Comparative Safety Scale(Higher is safer)

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95
DangerousModerateSafe

Time to Effect

4-8 weeks

Duration

8-12 sessions, skills for lifetime

Response Rate

60%

Remission Rate

35%

Number Needed to Treat (NNT)

5

Annual Cost of Care

Drug Cost

$0

Monitoring

$600

Side Effects

$0

Total Annual

$600

Cost-Effectiveness

GOOD

QALYs Gained

0.08

ICER

$60,000/QALY

Cost per Remission

$4,286

Cost per Responder

$2,500

Treatment Outcomes
Primary Outcomes
Premenstrual Symptom Severity (DRSP total score)70/100
-35% (-24.5 points)
Functional Impairment (Sheehan Disability Scale, SDS total score)18/30
-30% (-5.4 points)
Luteal Phase Mood Disturbance (Visual Analog Scale, 0-10)7.5/10
-40% (-3.0 points)
Secondary Benefits
Quality of Life (SF-36 Mental Health Component Summary Score)40/100
+15% (+6.0 points)
Self-Efficacy for Managing PMS Symptoms (Self-Efficacy Scale, 0-100)45/100
+25% (+11.25 points)
Interpersonal Relationship Strain (VAS 0-10)6.5/10
-20% (-1.3 points)

Clinical Trial Phases:

Phase 4
5
Calcium Supplementation
55% Effectiveness• 75% Confidence• 85% Safety• 1 trials• 4K participants
MODERATE EvidenceExcellent ValueDose: 1000-1200mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
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Morphine💊
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85
DangerousModerateSafe

Time to Effect

2-3 months

Duration

Continuous

Response Rate

45%

Remission Rate

20%

Number Needed to Treat (NNT)

8

Common Side Effects:

Constipation: 5%
Bloating: 3%

Annual Cost of Care

Drug Cost

$40

Monitoring

$600

Side Effects

$10

Total Annual

$650

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.03

ICER

$1,000/QALY

Cost per Remission

$250

Cost per Responder

$111

Treatment Outcomes
Primary Outcomes
Composite PMS Symptom Score28/50 points (higher is worse)
-30% (-8.4 points)
Emotional Symptom Severity (VAS)7/10 points (higher is worse)
-35% (-2.45 points)
Physical Symptom Severity (VAS)6/10 points (higher is worse)
-25% (-1.5 points)
Secondary Benefits
PMS-Related Quality of Life Score3.8/5 points (higher is worse)
-18% (-0.68 points)
Number of Symptom-Free Days (Luteal Phase)3 days/month
+66.67% (+2 days/month)
Common Side Effects
Constipation
+5%
Bloating
+3%

Clinical Trial Phases:

Phase 4
6
NSAIDs (Ibuprofen/Naproxen)
50% Effectiveness• 85% Confidence• 75% Safety• 2 trials• 15K participants
HIGH EvidenceExcellent ValueDose: Ibuprofen 200-400mg every 4-6h / Naproxen 220-440mg every 8-12h
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Comparative Safety Scale(Higher is safer)

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75
DangerousModerateSafe

Time to Effect

30-60 minutes

Duration

As needed (luteal phase)

Response Rate

70%

Remission Rate

10%

Number Needed to Treat (NNT)

3

Number Needed to Harm (NNH)

50

Common Side Effects:

Stomach upset: 10%
Heartburn: 8%
Headache: 5%

Annual Cost of Care

Drug Cost

$20

Monitoring

$600

Side Effects

$10

Total Annual

$630

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.02

ICER

$500/QALY

Cost per Remission

$300

Cost per Responder

$43

Treatment Outcomes
Primary Outcomes
Menstrual Cramp Severity7/10 on NRS (0-10)
-45% (-3.15 points)
Overall PMS Symptoms Score30/50 on a composite scale
-30% (-9 points)
Headache Severity6/10 on NRS (0-10)
-35% (-2.1 points)
Secondary Benefits
Interference with Daily Activities5/10 on impairment scale (0-10)
-30% (-1.5 points)
Rescue Analgesic Doses per Cycle3 doses/cycle
-50% (-1.5 doses/cycle)
Irritability Score6/10 on NRS (0-10)
-12% (-0.72 points)
Common Side Effects
Stomach upset
+10%
Heartburn
+8%
Headache
+5%

Clinical Trial Phases:

Phase 4
7
Vitamin B6
40% Effectiveness• 65% Confidence• 90% Safety• 4 trials• 2K participants
MODERATE EvidenceExcellent ValueDose: 50-100mg daily
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Comparative Safety Scale(Higher is safer)

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Meth💀
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90
DangerousModerateSafe

Time to Effect

1-2 months

Duration

Continuous or luteal phase

Response Rate

30%

Remission Rate

15%

Number Needed to Treat (NNT)

10

Common Side Effects:

Peripheral neuropathy (high doses): 1%
Nausea: 2%

Annual Cost of Care

Drug Cost

$30

Monitoring

$600

Side Effects

$5

Total Annual

$635

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.02

ICER

$1,200/QALY

Cost per Remission

$233

Cost per Responder

$117

Treatment Outcomes
Primary Outcomes
Overall Premenstrual Syndrome (PMS) Symptom SeverityTotal symptom score: 28/50 (based on a validated PMS symptom scale)
-35% (-9.8 points)
Mood-related PMS Symptoms (Irritability, Anxiety, Depression)Mood symptom subscore: 16/30 (based on a validated PMS symptom scale)
-40% (-6.4 points)
Physical PMS Symptoms (Bloating, Breast Tenderness, Headache)Physical symptom subscore: 14/25 (based on a validated PMS symptom scale)
-25% (-3.5 points)
Secondary Benefits
Impact on Daily ActivitiesImpact score: 6/10 (representing moderate interference)
-30% (-1.8 points)
Severity of Breast TendernessPain rating: 7/10 (on a Visual Analogue Scale)
-20% (-1.4 points)
Severity of BloatingSeverity rating: 3/5 (on a 5-point Likert scale)
-25% (-0.75 points)
Common Side Effects
Peripheral neuropathy (high doses)
+1%
Nausea
+2%

Clinical Trial Phases:

Phase 4