A review of treatment of premenstrual syndrome and premenstrual dysphoric disorder.

UCLA School of Medicine, Department of Obstetrics and Gynecology, Center for the Health Sciences, Los Angeles, CA 90095-1740, USA.
Psychoneuroendocrinology (Impact Factor: 5.14). 09/2003; 28 Suppl 3:39-53. DOI: 10.1016/S0306-4530(03)00096-9
Source: PubMed

ABSTRACT Severe premenstrual syndrome (PMS) and, more recently, premenstrual dysphoric disorder (PMDD) have been studied extensively over the last 20 years. The defining criteria for diagnosis of the disorders according to the American College of Obstetricians and Gynecologists (ACOG) include at least one moderate to severe mood symptom and one physical symptom for the diagnosis of PMS and by DSM IV criteria a total of 5 symptoms with 1 severe mood symptom for the diagnosis of PMDD. There must be functional impairment attributed to the symptoms. The symptoms must be present for one to two weeks premenstrually with relief by day 4 of menses and should be documented prospectively for at least two cycles using a daily rating form. Nonpharmacologic management with some evidence for efficacy include cognitive behavioral relaxation therapy, aerobic exercise, as well as calcium, magnesium, vitamin B(6) L-tryptophan supplementation or a complex carbohydrate drink. Pharmacologic management with at least ten randomized controlled trials to support efficacy include selective serotonin reuptake inhibitors administered daily or premenstrually and serotonergic tricyclic antidepressants. Anxiolytics and potassium sparing diuretics have demonstrated mixed results in the literature. Hormonal therapy is geared towards producing anovulation. There is good clinical evidence for GnRH analogs with addback hormonal therapy, danocrine, and estradiol implants or patches with progestin to protect the endometrium. Oral contraceptive pills prevent ovulation and should be effective for the treatment of PMS/PMDD. However, limited evidence does not support efficacy for oral contraceptive agents containing progestins derived from 19-nortestosterone. The combination of the estrogen and progestin may produce symptoms similar to PMS, such as water retention and irritability. There is preliminary evidence that a new oral contraceptive pill containing low-dose estrogen and the progestin drospirenone, a spironolactone analog, instead of a 19-nortestosterone derivative can reduce symptoms of water retention and other side effects related to estrogen excess. The studies are in progress, however, preliminary evidence suggests that the drospirenone-containing pill called Yasmin may be effective the treatment of PMDD.

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    ABSTRACT: Premenstrual syndrome (PMS) is used to describe physical, cognitive, affective, and behavioral symptoms that occur cyclically during the luteal phase of the menstrual cycle and resolve quickly at or within a few days of the onset of menstruation. The primary aim of the study was to assess the prevalence, impacts and medical managements of PMS on female medical students of Mekelle University College of Health Science. A cross-sectional study was conducted among systematically selected female students of Mekelle University College of Health Science, Mekelle town, northern Ethiopia from March to April 2013. A structured and pretested self-administered questionnaire was employed for data collection. The collected data were analyzed using the Statistical Package for the Social Sciences, SPSS Inc., Chicago, IL (SPSS version 16). The criteria proposed by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV TR) were used to diagnose PMS.Result: From the total population size of 608; a sample size of 258 was drawn. Age of the study participants ranged from 18 to 25 years, with mean age of 20.86 +/- 1.913 years. Among the participants, 144(83.2%) have had at least one PM symptoms with their menstrual period. The prevalence of PMS according to DSM-IV was 37.0%. About 49(28.3%) reported frequent class missing, 17(9.8%) exam missing, 14(8.1%) low grade scoring and 3(1.7%) of them reported withdrawal from their learning associated with their PMS. Only 83(48.0%) participants sought medical treatment for their PMS. The treatment modalities used were pain killers, 63(36.4%), hot drinks like coffee and tea, 13(7.5%), and massage therapy and exercise, 7(4.0%). Binary logistic regression analysis revealed average length of one cycle of menstruation (COR = 0.20(0.070-0.569)) and academic performance impairment (AOR = 0.345(0.183-0.653)) were significantly associated with the diagnosis of PMS and use PMS treatments respectively. Our study revealed a high prevalence and negative impact of PMS on students of Mekelle University. Therefore, health education, appropriate medical treatment and counseling services, as part of the overall health service, should be availed and provided to affected women.
    BMC Women s Health 03/2014; 14(1):52. · 1.51 Impact Factor
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    ABSTRACT: AIMS: Patients with premenstrual dysphoric disorder (PMDD) experience moderate to severe physical and mood symptoms during the luteal phase of their menstrual cycle. The purposes of this study were to examine whether there were significant differences in frontal alpha asymmetry between PMDD and non-PMDD women during a depressive induction condition during the luteal and follicular phases and to examine the relations between premenstrual distress and depressive symptoms, and frontal alpha asymmetry. MATERIAL AND METHODS: The participants included 12 college women with PMDD and 12 without PMDD as controls. Frontal electroencephalograms (F3/F4) were measured during the luteal and follicular phases of the menstrual cycle in the following sequence: resting baseline, depressive induction, depressive recall, recovery, and relaxation. Premenstrual distress questionnaires and the Beck Depression Inventory II were administered. RESULTS: The participants with PMDD had higher frontal alpha asymmetry than those without PMDD during the depressive induction and relaxation conditions only during the luteal phase. For PMDD and non-PMDD during the luteal phase, a positive correlation was observed between negative affect (measured by premenstrual distress questionnaires) and frontal alpha asymmetry under the depressive induction stage. In addition, higher Beck Depression Inventory II somatic depression was positively correlated with frontal alpha asymmetry under the depressive induction stage. CONCLUSIONS: This study supports the significant difference between PMDD and non-PMDD on frontal alpha asymmetry, and frontal alpha asymmetry was related to negative affect and somatic depression, while participants with PMDD were in the depressive mood during the luteal phase.
    Journal of Obstetrics and Gynaecology Research 04/2013; · 0.84 Impact Factor
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    ABSTRACT: In women with obsessive-compulsive disorder (OCD), symptom severity appears to fluctuate over the course of the menstrual cycle. The objective of this paper was to compare female OCD patients with and without premenstrual worsening of obsessive-compulsive symptoms (OCS), in terms of the clinical characteristics of OCD. This was a cross-sectional study involving 455 women with OCD, of whom 226 (49.7%) had experienced premenstrual OCS worsening and 229 (50.3%) had not (PMOCS-worse and PMOCS-same groups, respectively). Data were collected with the original and dimensional versions of the Yale-Brown Obsessive-Compulsive Scale, as well as with the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). We found significant differences between the PMOCS-same and PMOCS-worse groups, the latter showing a higher frequency of suicidal ideation (P<.001), suicide attempts (P=.027), current use of selective serotonin reuptake inhibitors (P=.022), lifetime use of mood stabilisers (P=.015), and sexual/religious obsessions (P<.001; OR=1.90), as well as higher scores on the BDI (P<.001) and BAI (P<.001). Underscoring the fact that OCD is a heterogeneous disorder, there appears to be a subgroup of female OCD patients in whom the premenstrual period is associated with a higher frequency of sexual/religious obsessions, depression, anxiety, and suicidality. This might be attributable to hormonal fluctuations. Further studies are warranted in order to investigate this hypothesis by evaluating such patients at different phases of the menstrual cycle, as well as measuring hormonal levels.
    Journal of psychosomatic research 04/2013; 74(4):313-9. · 2.91 Impact Factor


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