Women who suffer from severe PMS could be offered free psychotherapy on the NHS to ease the symptoms, if proposals from senior doctors are given the go-ahead. Around 40% of women experience psychological symptoms of PMS, such as depression, anxiety, irritability, loss of confidence and mood swings. For one in 20 women, the symptoms are so severe that they can lead to marriage breakdown, unemployment, self-harm and suicide, according to the Royal College of Obstetricians and Gynaecologists (RCOG). Doctors today recommended that women and girls with severe PMS be given cognitive behavioural therapy (CBT) as a first course of treatment for PMS. CBT is a talking therapy that encourages patients to manage their problems by altering their thoughts and behaviour. To qualify for the therapy, a sufferer's symptoms would have to affect her daily functioning or interfere with her work or relationships. Many people still fail to appreciate the debilitating impact PMS can have on some women's lives, said Shaughn O’Brien, professor of obstetrics and gynaecology at Keele University and lead author of the advice. “PMS can be a serious condition which can dramatically impact on the quality of a woman’s life affecting her personal and professional life, therefore it is essential that an integrated holistic approach to treatment is adopted." He said that while many women's symptoms can be treated by their GP and through lifestyle changes, taking the contraceptive pill, SSRIs or vitamin B6, others "will need more complex care provided by a team of GPs, gynaecologists, psychiatrists and dieticians". The last resort for treating severe PMS is removing the womb and both ovaries. But many doctors believe women shouldn't have to go through invasive procedures, and there is strong evidence that CBT is as effective for treating PMS as Prozac, O’Brien told The Times. "[CBT] is an action that continues. Once you stop a drug the patient goes back to where they were; CBT sets them up for the future and they can return to it by themselves,” he added. CBT is available on the NHS with a referral from your GP, however many patients report long waiting lists and end up paying for treatment from a private therapist, which can cost between £40 and £100 for a session, reported The Times. However, not everyone believes offering free CBT to treat PMS is a good idea. Writing in The Guardian, clinical psychologist and psychotherapist Jay Watts said "medicalising" PMS risks encouraging women – half of the population – to view their experiences as "abnormal". "The issues that the emotional premenstrual surge often attempt to communicate are often far from irrational," she wrote. "The sudden fury, say, at always doing the washing-up, the feelings of not being appreciated, being ugly; such issues are deeply embedded within gender dynamics." Framing PMS as a disorder requiring medical intervention, she added, is a "political act" that obscures many women's disadvantaged place in society, and shouldn't be offered by a "broke" NHS.