A review of treatment of premenstrual syndrome & 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: 4.94). 09/2003; 28 Suppl 3(3):39-53. DOI: 10.1016/S0306-4530(03)00096-9
Source: PubMed


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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    • "There are numerous pieces of evidence pointing to changes in serotonergic conductivity of the central nervous system in PMDD and PMS. This relationship has been confirmed by the positive therapeutic effects of serotonergic inhibitors in women suffering from PMS/PMDD [23] [24] such that fluoxetine and sertraline have been recognized as effective in the treatment of physical and psychological signs, the improvement of job performance, and the quality of life of women suffering from the syndrome [13,25–27]. Nowadays, the use of complementary medicine and herbal products has gained a lot of popularity in the treatment of conditions such as menopausal symptoms, dysmenorrhea, and premenstrual syndrome [28] [29] [30] [31]. "
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    ABSTRACT: Introduction: Premenstrual syndrome is one of the most common problems for women during their reproductive age and has wider impacts affecting their family and their work. Herbal products are a suggested way of treating the syndrome. This research was carried out to identify whether saffron could have an effect on the severity of premenstrual syndrome among female students. Methods: This randomized triple-blind controlled clinical trial was carried out with 78 students aged 18-35 years residing in university accommodation. The intervention group received capsules containing 30. mg of dried extract of saffron stigma once a day and the control group received placebo capsules for two menstrual cycles. The data gathering instrument consisted of questionnaire, the DASS21 scale, and premenstrual symptoms assessment form. Results: At the beginning of the study, the two groups did not differ significantly in terms of their mean severity of PMS (P = 0.81). At the end of the study, the changes of the mean severity of PMS were significantly different compared with those in the beginning: P <. 0.001 for the intervention group, and p = 0.04 for the control group. In total, the two groups had significant differences in terms of changes in the mean severity of PMS over time (P <. 0.001). Conclusion: The results of this study suggest that saffron reduces the severity of PMS symptoms, but in order to prove its effectiveness for the treatment of this syndrome, further research is warranted.
    Full-text · Article · Jul 2015 · European Journal of Integrative Medicine
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    • "Interessant nok forverret behandling med Strattera symptomer både på depresjon og intensitet av suicidal atferd, mens det sykliske mønsteret forble uforandret. Behandling Flere dobbelt-blind-plasebokontrollerte studier har vist positiv effekt av medisiner som øker serotoninkonsentrasjonen i hjernen for å behandle PMDD (oppsummert i en oversiktsartikkel av Rapkin, 2003). Pasientens tilstand har blitt betydelig bedre etter behandling med Zoloft (Sertralin). "

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    • "Until recently, the focus on single, usually pharmacologic therapy has dominated the treatment of PMS. But now clinical research suggests that combination of treatments including pharmacotherapies (like selective serotonin reuptake inhibitors (SSRIs), anxiolytic agents, gonadotropin-releasing hormone (GnRH) agonists, the diuretic spironolactone, non-steroidal anti-inflammatory drugs and combination oral contraceptives (OCs)), cognitive and behavioral therapies, aerobic exercises, homeopathic remedies, reflexology, light therapy, massage therapy, dietary and nutritional modifications have been used over the years to treat premenstrual symptoms are more beneficial than are single treatments [19-25]. Hence, the primary aim of this study was to assess the prevalence, impacts and medical managements of PMS on female students of College of Health Sciences students, Mekelle University. "
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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.
    Full-text · Article · Mar 2014 · BMC Women's Health
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