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Biochemical and clinical effects of treating the premenstrual syndrome with prostaglandin synthesis precursors
Abstract
The clinical and biochemical effects of a prostaglandin synthesis precursor (Efamol) containing linoleic acid and its metabolite, gamma-linolenic acid, were studied in 30 women with severe, incapacitating premenstrual syndrome. Efamol treatment alleviated the premenstrual symptoms in general and depression especially better than did a placebo. The capacity of platelets to release thromboxane B2 during spontaneous clotting was decreased in patients undergoing Efamol treatment (141 +/- 59 ng/ml, mean +/- SD) as compared to those undergoing placebo treatment (186 +/- 44 ng/ml, p less than 0.01) and control subjects (176 +/- 40 ng/ml, n = 25, p less than 0.05). No changes were found in plasma 6-keto-prostaglandin F1alpha or in FSH, LH, prolactin, progesterone, estradiol and testosterone. The data suggest that prostaglandins might play a role in the pathophysiology of the premenstrual syndrome.
... Three RCTs evaluating the efficacy of evening primrose oil (EPO) met inclusion criteria ( Table 2). [18][19][20] No significant reduction in total PMS symptoms was detected in any of the three studies, even with the wide range of doses used which varied from 0.27 g 18 and 0.36 g 19 to 6.48 g 20 of linolenic acid per day. Two of the three RCTs were judged to be of sufficient quality to apply results to practice. ...
... 19,20 There was, however, a statistically greater reduction in depression symptoms with EPO as compared to placebo in one trial, although this trial was judged to be of lesser quality. 18 Only one study mentioned adverse effects, reporting perceived weight gain and difficulty swallowing. 20 However, it was not clear from the report of the RCT if these symptoms occurred in the treatment or placebo group. ...
... EPO was evaluated in three RCTs using a range of doses of standardized commercial products. [18][19][20] Duration of the studies varied from 4 to 10 months. Despite the range of dose and the long duration of study, no improvement in symptoms of PMS, with the exception of a reduction in depression in one trial, could be detected. ...
As many women experiencing symptoms of premenstrual syndrome (PMS) seek relief from natural products (NP), health care providers should have quality information available to aid women in making evidence-based decisions regarding use of these products.
To identify herbs, vitamins and minerals advocated for the treatment of PMS and/or PMDD and to systematically review evidence from randomized controlled trials (RCTs) to determine their efficacy in reducing severity of PMS/PMDD symptoms.
Searches were conducted from inception to April 2008 in Clinical Evidence, The Cochrane Library, Embase, IBID, IPA, Mayoclinic, Medscape, MEDLINE Plus, Natural Medicines Comprehensive Database and the Internet to identify RCTs of herbs, vitamins or minerals advocated for PMS. Bibliographies of articles were also examined. Included studies were published in English or French. Studies were excluded if patient satisfaction was the sole outcome measure or if the comparator was not placebo or recognized therapy.
Sixty-two herbs, vitamins and minerals were identified for which claims of benefit for PMS were made, with RCT evidence found for only 10. Heterogeneity of length of trials, specific products and doses, and outcome measures precluded meta-analysis for any NP. Data supports the use of calcium for PMS, and suggests that chasteberry and vitamin B6 may be effective. Preliminary data shows some benefit with ginkgo, magnesium pyrrolidone, saffron, St. John's Wort, soy and vitamin E. No evidence of benefit with evening primrose oil or magnesium oxide was found.
Only calcium had good quality evidence to support its use in PMS. Further research is needed, using RCTs of adequate length, sufficient sample size, well-characterized products and measuring the effect on severity of individual PMS symptoms.
... The remaining 17 RCTs were considered eligible for this review. Eight of them pertains the effects of Vitex agnus-castus3637383940414243, four used Oenotera biennis44454647, two used Hypericum perforatum4849, two used Ginkgo biloba [50,51] and one Crocus sativus [52]. Each one of such RCT was detailed inTable I. ...
... Each one of such RCT was detailed inTable I. The analysis through the Jadad method showed three studies of poor quality (score 53) [40, 41,47] which were excluded. In addition, further four studies were excluded since they did not report a reliable standardised definition of either PMS or PMDD diagnosis [36,39,45,50]. ...
Premenstrual syndrome (PMS) is a condition of cyclical and recurrent physical and psychological discomfort occurring 1 to 2 weeks before menstrual period. More severe psychological symptoms have been described for the premenstrual dysphoric disorder (PMDD). No single treatment is universally recognised as effective and many patients often turn to therapeutic approaches outside of conventional medicine. This systematic review is aimed at analysing the effects of herb remedies in the above conditions. Systematic literature searches were performed in electronic databases, covering the period January 1980 to September 2010. Randomised controlled clinical trials (RCTs) were included. Papers quality was evaluated with the Jadad' scale. A further evaluation of PMS/PMDD diagnostic criteria was also done. Of 102 articles identified, 17 RCTs were eligible and 10 of them were included. The heterogeneity of population included, study design and outcome presentation refrained from a meta-analysis. Vitex agnus castus was the more investigated remedy (four trials, about 500 women), and it was reported to consistently ameliorate PMS better than placebo. Single trials also support the use of either Gingko biloba or Crocus sativus. On the contrary, neither evening primrose oil nor St. John's Wort show an effect different than placebo. None of the herbs was associated with major health risks, although the reduced number of tested patients does not allow definitive conclusions on safety. Some herb remedies seem useful for the treatment of PMS. However, more RCTs are required to account for the heterogeneity of the syndrome.
... 86 A subsequent study found that 1080 mg EPA 1 720 mg DHA 1 1.5 mg vitamin E taken daily for 2 months resulted in a marked reduction in menstrual symptoms from baseline in adolescents with dysmenorrhea, including mood symptoms. 87 Three of 4 RCTs found no benefit of 3 to 6 g evening primrose oil, which contains the omega-6 fatty acid g-linolenic acid, [88][89][90][91] in the reduction of menstrual symptoms versus placebo. One study found a small additional benefit of 3 g of omega-6 fatty acid taken for 4 menstrual cycles in reducing menstrual and depressive symptoms compared with that observed with placebo, but that study did not confirm PMS diagnoses and was not double-blinded. ...
... One study found a small additional benefit of 3 g of omega-6 fatty acid taken for 4 menstrual cycles in reducing menstrual and depressive symptoms compared with that observed with placebo, but that study did not confirm PMS diagnoses and was not double-blinded. 88 Overall, there is insufficient evidence to support the efficacy of omega-3 or omega-6 fatty acid treatment of PMS or PMDD. ...
Complementary and alternative medicine (CAM) therapies are commonly practiced in the United States and are used more frequently among women than men. This article reviews several CAM treatments for depressive disorders in women, with a focus on major depressive disorder across the reproductive life cycle. The CAM therapies selected for this review (ie, S-adenosylmethionine, omega-3 fatty acids, St John's wort, bright light therapy, acupuncture, and exercise) were based on their prevalence of use and the availability of randomized, placebo-controlled data. Further study is necessary to delineate the role of specific CAM therapies in premenstrual syndrome, premenstrual dysphoric disorder, antepartum and postpartum depression, lactation, and the menopausal transition.
... It is also assumed that low levels of prostaglandin E1 in women with premenstrual syndrome lead to increased sensitivity to luteal phase prolactin 71 . Research studies and findings which proposed a possible connection between premenstrual syndrome, prolactin levels, prostaglandins and γ-linolenic acid, an essential fatty acid precursor of prostaglandin E1, originate from the early 1980s 72,73 , including first clinical studies showing success in the treatment with Oenothera oil, for premenstrual syndrome 74 and mastalgia 75 . Data showed that women with premenstrual syndrome have the inability to convert linoleic acid to γlinolenic acid due to a decreased activity of the delta-6 desaturase enzyme 76,82 , in addition to hormonal disbalance 71 . ...
Herbal products are often used as an alternative to pharmacological therapy. Menopausal symptoms and gynecological disorders (such as premenstrual syndrome and dysmenorrhea) are the indications where pharmacological therapy may have serious adverse events; hence many women prefer to use herbal products to help with these symptoms. Here, we reviewed plants and derived products, which are commonly used for the abovementioned indications, focusing on clinical data, safely profile and whether or not their use is justified. We noted that limited data are available on the use of some plants for alleviating the symptoms of menopause and gynecological disorders. While black cohosh (Cimicifuga racemose) and red clover (Trifolium pretense) were consistently shown to help reduce menopausal symptoms in clinical studies, currently available data do not fully support the use of fenugreek (Trigonella foenum-graecum), hops (Humulus lupulus), valerian (Valeriana officinalis), and soybean (Glycine max and Glycine soja) for this indication. For premenstrual syndrome and premenstrual dysphoric disorder, chaste tree (Vitex agnus-castus) shows effectiveness, but more clinical studies are needed to confirm such effect upon the use of evening primrose (Oenothera biennis). Keywords: Menopause; Dysmenorrhea; Premenstrual syndrome; Gynecological disorders; Herbal products; Medicinal plants.
... It is also assumed that low levels of prostaglandin E1 in women with premenstrual syndrome lead to increased sensitivity to luteal phase prolactin [62]. Research studies and findings which proposed a possible connection between premenstrual syndrome, prolactin levels, prostaglandins and γ-linolenic acid, an essential fatty acid precursor of prostaglandin E1, originate from the early 1980s [63,64], including first clinical studies showing success in the treatment with Oenothera oil, for premenstrual syndrome [65] and mastalgia [66]. Data showed that women with premenstrual syndrome have the inability to convert linoleic acid to γ-linolenic acid due to a decreased activity of the delta-6 desaturase enzyme [67], in addition to hormonal disbalance [62]. ...
Herbal products are often used as an alternative to pharmacological therapy. Menopausal symptoms and gynecological disorders (such as premenstrual syndrome and dysmenorrhea) are the indications where pharmacological therapy may have serious adverse events, hence many women prefer to use herbal products to help with these symptoms. Here, we reviewed plants and derived products, which are commonly used for the abovementioned indications, focusing on clinical data, safely profile and whether or not their use is justified. We noted that limited data are available on the use of some plants for alleviating the symptoms of menopause and gynecological disorders. While black cohosh (Cimicifuga racemose) and red clover (Trifolium pretense) were consistently shown to help reduce menopausal symptoms in clinical studies, currently available data do not fully support the use of fenugreek (Trigonella foenum-graecum), hops (Humulus lupulus), valerian (Valeriana officinalis), and soybean (Glycine max and Glycine soja) for this indication. For premenstrual syndrome and premenstrual dysphoric disorder, chaste tree (Vitex agnus-castus) shows effectiveness, but more clinical studies are needed to confirm such effect upon the use of evening primrose (Oenothera biennis).
... Evening primrose oil (EPO) (72% cis-hnoleic acid and 9% gammalinolenic acid) has therefore been considered as a logical treatment for PMS. Puolakka et al (1985) in a double bhnd cross over trial demonstrated EPO to be superior to placebo on global symptom assessment. Massil et al (1987) have also shown similar results. ...
The aims of this thesis were to study fluid, electrolyte and hormonal changes during the menstrual cycle and to determine their relationship to symptoms in patients suffering from Premenstrual Syndrome (PMS). The fluid and electrolyte changes were assessed in relationship to psychological and somatic symptoms, but particularly bloatedness, which has long been considered to be due to water retention or fluid shifts. The first study demonstrated atrial natriuretic peptide (ANP) to be significantly lower in patients compared to controls throughout the menstrual cycle, with a significant decrease in the luteal phase of the patients. Mid-luteal ANP concentrations showed a strong negative correlation with PMS symptoms. Cycle simulation with hormones resulted in a significant fall in ANP during oestrogen replacement only. Vascular permeability taken as the 0-10 minute albumin change before and after application of venous pressure, demonstrated a significant increase in the patients in the luteal phase, suggesting increased fluid permeability. Total body water, extracellular fluid, and plasma volume demonstrated no significant change in either group from follicular to luteal phases. There was a follicular to luteal phase decrease in total body exchangeable sodium in both patients and controls. This decrease was significantly different when compared between patients and controls. Creatinine and urea significantly increased, whereas the urinary volume significantly decreased in patients compared to controls in the luteal phase. Follicle stimulating hormone and luteinising hormones were both significantly lower, whilst the oestrogen concentration was significantly higher in the luteal phase when compared to the follicular phase in patients. There was no significant relationship of symptoms to any parameter measured apart from the finding that weight change from the follicular to luteal phase being related to breast and bloatedness scores in patients. The results presented contradict the widely held view that PMS is associated with substantial sodium and water retention or fluid shifts. However possible changes of vascular permeability and exchangeable sodium were detected in the patients which is likely to be related to the hormonal changes demonstrated in the studies.
... 23,51 However, many other studies including certain randomized, placebo-controlled, double-blind clinical trials have found EPO to have no efficacy in the treatment of cyclic mastalgia. [52][53][54] Trials have been conducted in which EPO was administered along with some other elements with equivocal results. Pruthi et al. conducted a double-blind, randomized, placebo-controlled trial at 2 academic medical centres in the United States to evaluate the effectiveness of vitamin E, EPO, and a combination of vitamin E and EPO for pain control in women with cyclic mastalgia. ...
... With prolonged high dose treatment (320 mg/day for 3-6 months), the GLA content of EPO has been found to thereby alleviating the pain (26). However, many other studies including certain randomized, placebo-controlled, double-blind clinical trials have shown no efficacy for EPO in the treatment of cyclic mastalgia (27)(28). Use of Danazol of uncertain dose for short periods was reported by 4 (2.3%) subjects but had not been helpful in alleviation of pain though no mention of adverse effects was made. ...
BACKGROUND: Mastalgia is a common breast symptom experienced by females of reproductive age. The purpose of this study was to analyze the profile of females with mastalgia. METHODS: This cross sectional study was conducted in June 2017 in the Department of Surgery, Unaizah College of Medicine, Qassim University, Saudi Arabia. A self designed questionnaire was used to interview the females after proper explanation and consent. RESULTS: 979 females participated and prevalence of mastalgia was found to be 59%. Most of the patients experienced pain for less than 7 days per month. Reassurance was the main modality of management. CONCLUSION: Mastalgia is a common breast symptom with prevalence of about 59% that is comparable to that of western populations. There is a suggestion for further studies to gain greater understanding of this disease.
... Approximately blinded and controlled studies failed to find to find a difference while comparing primrose oil with a placebo. The one present study used retrospective assessment of systems, a method known to be inaccurate [23]. ...
Premenstrual Syndrome (PMS) comprises a range of physical, psychological and behavioral symptoms experienced by many premenopausal women during the luteal phase of the menstrual cycle. They experience symptoms like irritability, depression, sleep disorders, breast discomfort, headache, weight gain, changes in appetite, feeling of bloatedness etc. While premenstrual dysphoric disorders is a severe subtype of PMS when a woman is suffering from atleast 5 distinct psychological premenstrual symptoms. Based on the RCOG guideline, exercise, cognitive behavioral therapy (CBT), vitamin B6, new generation combination oral contraceptives having drospirenone (cyclically or continuously) and or low dose selective serotonin reuptake inhibitors (SSRI's) used continuously during the luteal phase as 2 nd line treatment. Gonadotropin analogues with add back hormonal therapy are recommended as 3 rd line treatment, with TAH (total abdominal hysterectomy) with BSO (bilateral salpingooophorectomy) as 4 th line treatment. Although progestogens were the most common prescribed treatment earlier it is no longer found desirable, as has the prescription of vitamin B6 decreased, although SSRI prescribing has increased. It is suggested to classify the PMS subtype based on sertraline response for individualized treatment.
... γ-Linolenic acid (GLA), (omega 6) has attracted attention worldwide because of its medicinal value with regard to cardiovascular diseases, hyper-cholesterolaemia, Horrobin menstrual disorders, skin diseases (atopic eczema) and other disorders. [35][36][37][38] The balance of omega fatty acids is important to consider. The so-called omega-3:omega-6 ratio has become a model for gauging the proper balance of these fats in oils and the diet. ...
The aim of the current study is to investigate the production of essential omega fatty acids 3, 6 and 9 from four species of microalgae which were Chlamydomonas variabills, Chlorella vulgaris, Haematococcus pluvialis and Spirulina platensis. The results showed that Chlamydomonas variabills has the highest lipid content (21%) with high concentration of omega 6 (29.24%). Chlorella vulgaris showed 12% total lipid with high concentration of omega3 (21.17%). Spirulina platensis is a highly important cyanobacteria species, it contains 15.8% lipid with 4.9% omega 3 fatty acid. In addition, omega 9 was detected only in Spirulina platensis with percentage 3.22%. Although, Haematococcus pluvialis has the lowest total lipid percentage (10%), it revealed a detectable amount of omega 6 fatty acids (14.83%). The ratio of omega 3 to omega 6 depends on the algal species, in Chlorella vulgaris and Chlamydomonas variabills, it is in the recommended healthy range. The most common fatty acids methyl ester of the algal species were also identified.
... Evening Primrose oil (Efamol) has also been advocated by many researchers for general symptoms of depression, irritability, anxiety, fluid retention, cravings, headache and breast discomfort. Puolakka, Makarainen, Viinikka and Ylikorkala (1985) have observed an improvement in mastalgia and depression after use of Evening Primrose oil. Casey and Dwyer (1987) argue that there is no evidence that PMS is caused by a poor diet or vitamin/mineral deficiency, or that it can be prevented or cured by dietary therapy. ...
... Out of 59 originally selected studies, one [31] was excluded because of having a non-randomize non-placebo controlled design; two [32,33], because there was used a dietary intervention design; five [34][35][36][37][38], because the depressive status was reported as a categorical variable rather than a rating scale; two [39,40], because an inadequate or poorly comparable rating score of depression was used; two [41,42], because poorly comparable omega-3 PUFA or placebo preparations. This selection strategy resulted in a final selection of 47 studies eligible to be included in the present systematic review. ...
Despite omega-3 polyunsaturated fatty acids (PUFA) supplementation in depressed patients have been suggested to improve depressive symptomatology, previous findings are not univocal.
To conduct an updated meta-analysis of randomized controlled trials (RCTs) of omega-3 PUFA treatment of depressive disorders, taking into account the clinical differences among patients included in the studies.
A search on MEDLINE, EMBASE, PsycInfo, and the Cochrane Database of RCTs using omega-3 PUFA on patients with depressive symptoms published up to August 2013 was performed. Standardized mean difference in clinical measure of depression severity was primary outcome. Type of omega-3 used (particularly eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) and omega-3 as mono- or adjuvant therapy was also examined. Meta-regression analyses assessed the effects of study size, baseline depression severity, trial duration, dose of omega-3, and age of patients.
Meta-analysis of 11 and 8 trials conducted respectively on patients with a DSM-defined diagnosis of major depressive disorder (MDD) and patients with depressive symptomatology but no diagnosis of MDD demonstrated significant clinical benefit of omega-3 PUFA treatment compared to placebo (standardized difference in random-effects model 0.56 SD [95% CI: 0.20, 0.92] and 0.22 SD [95% CI: 0.01, 0.43], respectively; pooled analysis was 0.38 SD [95% CI: 0.18, 0.59]). Use of mainly EPA within the preparation, rather than DHA, influenced final clinical efficacy. Significant clinical efficacy had the use of omega-3 PUFA as adjuvant rather than mono-therapy. No relation between efficacy and study size, baseline depression severity, trial duration, age of patients, and study quality was found. Omega-3 PUFA resulted effective in RCTs on patients with bipolar disorder, whereas no evidence was found for those exploring their efficacy on depressive symptoms in young populations, perinatal depression, primary disease other than depression and healthy subjects.
The use of omega-3 PUFA is effective in patients with diagnosis of MDD and on depressive patients without diagnosis of MDD.
... 40 Two other studies indicated statistically significant improvement particularly with the symptoms of depression and irritability. 41,42 Mechanism of Action: Since PGE1 inhibits glucose induced insulin secretion, a deficiency, occurring either as a result of an inadequate intake of essential fatty acids in the form of cis-linoleic acid or problems with conversion to GLA, could result in symptoms of hypoglycemia, cravings for sweets and increase in appetite reported by many PMS patients. 24 Previously discussed nutrients, magnesium and B6 (as well as zinc, niacin and vitamin C), are important for the conversion of cis-linoleic acid to PGE1. ...
Since it was first identified in the 1930s, premenstrual syndrome (PMS) has presented the clinician with challenges from an etiological as well as treatment perspective. To know the cause is to know the cure. The cause of PMS appears to be a complicated interplay among hormones, neurotransmitters, nutrients and psychosocial factors. To complicate the picture further, the same imbalances are not present in every person suffering from PMS. This article is a review of the literature, citing numerous studies, sometimes with conflicting views, of the etiology and non-drug treatment for premenstrual syndrome. Specific nutrients and botanicals are discussed as they relate to particular neuroendocrine imbalances. In view of the fact that there appears not to be one particular deficiency or excess which can be identified in each case of PMS, the most reliable method of treatment involves a comprehensive approach which includes dietary changes, supplementation of specific nutrients and botanicals, and when indicated, use of identical to natural hormones such as progesterone. (Alt Med Rev 1997;2(1):12-25)
... Although most trials evaluating Agnus castus treatment reported positive effects, many studies also suffered methodological problems. Though some studies suggest evening primrose oil may benefit PMS symptoms (Ockerman et al., 1986;Puolakka et al., 1985), currently the evidence is not convincing, especially as the most methodologically sound study (Collins et al., 1993) found no benefit for mood or physical symptoms. Therefore, trials with longer treatment durations, tighter controls and larger samples are required to evaluate Agnus castus, evening primrose oil and mg supplementation in PMS. ...
Many women with PMS use alternative therapies, although there has been little research to demonstrate their efficacy. This systematic review provides a comprehensive discussion of dietary supplements and herbal remedies commonly used for premenstrual syndrome (PMS), including calcium, magnesium, vitamin B6, evening primrose oil, Vitex agnus castus, ginkgo biloba and St John's Wort. Randomized controlled trials of magnesium and evening primrose oil have produced conflicting results, in contrast to the substantial evidence for the efficacy of calcium and vitamin B6. There are insufficient data to advocate the use of ginkgo biloba, Vitex agnus castus and St John's Wort, although preliminary data seem supportive. Greater standardization of PMS diagnosis and assessment, with randomized, double‐blind, placebo‐controlled trials using larger, representative samples, strict, prospectively confirmed diagnostic criteria and assessment of treatment efficacy, would help to clarify the role of these alternative PMS treatments. Although much of the clinical research is preliminary and/or inadequately controlled, this review will be relevant to the practicing clinician looking for greater understanding of the alternative therapies available to their patients with PMS.
... On the other hand, the East Asian literature did examine non-pharmacologic treatments for PMDD. In the West such treatments include Omega-3 fatty acid, 30 exercise, 31 massage therapy, 32 reflexology, 33 biofeedback, 34 calcium, 35 Vitamin B6 supplementation, 36 and chaste-berry. 37 Psychotherapeutic strategies, such as cognitive-behavioral therapy, 38 have also been utilized. ...
Fluctuations in ovarian steroids during specific phases of the reproductive cycle, such as pre-menstruation, have been hypothesized to contribute to women's increased vulnerability to depression. This current study's goal is to summarize the literature regarding Premenstrual Dysphoric Disorder (PMDD) in the East Asian countries of Taiwan, China (including Hong Kong and Macau), Japan, and Korea.
A Pubmed and Chinese Electronic Periodical Service (CEPS) literature review was conducted using the key words "Premenstrual Dysphoric Disorder" along with "Japan," rea," "Taiwan," "Hong Kong," and "Macau." Using these criteria, 17 articles were found. Three articles were excluded because they did not involve PMDD in the aforementioned countries. In addition to this search, an article found in a review of the research on reproductive mental health disorders in China was utilized. That review contained one article regarding PMDD with an English language abstract, which was utilized in this current article.
The rates of PMDD in East Asia (1.3-2.8%) appear to be lower than that seen in the Western literature (3-8%). Many of the risk factors for PMDD were the same in the Eastern and Western literature, although some key differences were found. The few studies on treatment of PMDD in East Asia have shown positive results.
The rates of PMDD appear to be lower in East Asia, though reasons for this result are discussed. Few studies have been conducted examining the efficacy of psychotropic medications commonly used to treat PMDD in this population.
... In the brain, essential fatty acids (EFA) help to prevent stroke, possibly through potential mechanisms of decreased blood pressure, reduced platelet aggregation and enhanced deformability of erythrocyte cells. Conditions of the brain such as depression, attention deficit, hyperactivity disorder and pre-menstrual syndrome are also thought to be attenuated by EFA (Iso et al., 2002; Stevens et al., 2003; Puolakka et al., 1985 ). Preterm infants deprived of vital fatty acids, particularly w-3 fatty acid, during late pregnancy are likely to have failures of normal development, especially development of the visual system (Auestad et al., 2003; Uauy et al., 2001) and are prone to diabetes in later life (Innis, 1992). ...
Fats, particularly saturated fats, are always considered to be health hazard due to its link with cholesterol level in blood, as evidenced by Framingham study. Raheja observed that in mid seventies of the past century Indians developed a strong belief that cholesterol in blood was the main offender leading to heart diseases latter on and changed the dietary patterns, particularly oil medium to poly unsaturated fatty acids rich oils like sunflower oil or safflower oil etc. taking these as cholesterol reducers. Different workers reported that optimum quantities of different groups of fats are essential for maintenance of health. It was found that the quality of fats and the life style patterns were most important in causing the diseases particularly type 2 diabetes mellitus and other related diseases like hypertension, coronary heart disease, dyslipidaemia, obesity. The paper shows the importance of lifestyle patterns in rural Bengalese in causing the disease and observed that their dietary fat intake was not detrimental to health of diabetics.
... The bioconversion of LA to GLA is catalyzed by the enzyme delta-6-desaturase; but several factors, including stress, diabetes, consumption of alcohol and ageing, can reduce or inhibit the activity of this enzyme, leading to a variety of ailments (1)(2)(3). Dietary supplementation of GLA with naturally derived oils has been reported to be of value in treating several pathological conditions (4)(5)(6)(7)(8)(9). ...
The oil extracted from the seeds ofOenothera biennis L. (evening primrose) is a major commercial source of gamma-linolenic acid, a fatty acid having potential therapeutic value
in the treatment of several diseases. This fatty acid is prone to oxidation and thermal rearrangement; therefore, the conventional
recovery of the oil via mechanical expression and hexane extraction must be carried out under very mild and controlled conditions.
In this study, supercritical fluid extraction with carbon dioxide has been employed as an alternative method to recover evening
primrose oil (EPO). Extractions were performed over the pressure range of 20–70 MPa and at temperatures from 40 to 60°C, with
a CO2 mass flow rate of 18 g/min. The experimental data permitted the determination of EPO solubility in supercritical CO2 at the tested extraction conditions. Supercritical fluid Chromatographic analysis of fractions collected during the extraction
showed a subtle shift in the triglyceride composition. Fatty acid methyl ester analysis on similar fractions indicated that
the fatty acid content was invariant with respect to extraction time.
... Es un período de «entrenamiento» para que la paciente se acostumbre al registro diario C. Una vez completado el tiempo de registro de 2 meses y una semana, se compara la puntuación media por día de ambos períodos foliculares (días 1 a 13) con la puntuación media por día de ambos períodos lúteos (días 13 hasta fin de ciclo). Una puntuación media lútea que supera en un 50% o más a la media folicular se considera 502 ha podido demostrar la superioridad del aceite sobre el placebo [51][52][53][54][55] . ...
Premenstrual symptoms probably constitute the physical and psychological alteration that affects more people than any other, including both women and the men in their environment. Up to 90% of women of childbearing age report one or more symptoms during the days before menstruation. These symptoms can alter women’s behavior and well-being and can therefore affect their family, social and work circles. Despite its widespread prevalence, premenstrual syndrome as a clinical entity has not been clearly defined, and consensuated and proven diagnostic methods are lacking. Treatment recommendations supported by experimental and clinical evidence are only slowly beginning to appear. In the present review, we discuss recently published experimental data on the possible etiology of premenstrual syndrome. We propose a new symptom register, the Premenstrual Profile, tobe used for the diagnosis of the three forms in which this alteration can manifest itself. Finally, we review evidence-based recommendations from reliable sources on the treatment of «normal» and «abnormal» premenstrual symptoms.
... Jakubowicz et al (1984) demonstrated lower serum levels of prostaglandin E2, prostaglandin F2-alpha, and prostaglandin F2 in PMS patients, compared with controls. Several studies demonstrated that EPO may indeed improve PMS under certain circumstances (Puolakka et al, 1985;Pye et al, 1985). ...
Premenstrual syndrome (PMS) is a common syndrome experienced by women during their reproductive years. Up to 95% of women experience PMS with 30% experiencing moderate
to severe symptoms and in 5-10% of women, the symptoms of PMS often result in work and/or social impairment which disrupts the quality of their lives.
The aetiology of PMS from a Western medical perspective still remains unclear even though numerous theories has been proposed. Although some pharmacological agents have proven effective and are widely used to treat the disorder, at present there are no approved medications for this disorder. In addition, most of these agents have adverse effects which limits their use in some patients. On the other hand, the aetiology of PMS from a Traditional
Chinese Medicine (TCM) point of view is quite clear. However, until now, there have been no rigorous TCM clinical trials on PMS. Many clinical trials in acupuncture are seriously flawed by methodological problems.
This study was designed to evaluated the efficacy of Traditional Chinese Acupuncture for the treatment of PMS. Twenty-six subjects were grouped according to age and then the TCM pattern of disharmony. The subjects within each age and TCM pattern group, were then randomly assigned to a treatment group which received real acupuncture treatment or to a control group which received sham acupuncture treatment.
... The 2 trials with sound methodology were conducted in a small number of patients (n = 49 and n = 30) and failed to demonstrate any benefits of evening primrose oil over placebo. 45,46 The short duration of these trials and the small number of patients studied leave the true benefits questionable. At this time, there is insufficient data to recommend treatment of PMS symptoms with evening primrose oil. ...
Women often seek alternative treatment options such as herbs, dietary supplements, and vitamins and minerals to treat women's health issues across the lifespan. Women may use complementary and alternative supplements for dysmenorrhea, premenstrual syndrome, infertility, nausea and vomiting during pregnancy, and symptoms of menopause. In general, there is a deficit of well-designed, randomized, controlled trials to evaluate the efficacy and safety of complementary and alternative medicine for these indications, which makes it difficult to provide evidence-based recommendations. This review outlines the evidence for efficacy and safety that is currently available for dietary supplement use by women to manage health conditions specific to the female patient.
... ).A number of clinical studies have demonstrated that GLA supplementation with evening primrose oil reduces the symptoms of premenstrual syndrome(Puolakka et al. 1985, Budeiri et al. 1996). In addition, results from clinical studies showed that evening primrose oil has times per day), providing approximately 240-560 mg of GLA(Fan et al. 1998). ...
Evening primrose has a good potential to become a commercial agricultural plant for GLA production, some disadvantages such as indeterminate inflorescence, high seed shattering during ripening, length of life cycle, lack of uniformity in seed germination are still problems to be overcome for this to happen. Although several studies have carried out to find ways of removing the seed shattering as well as reducing the flowering heterogeneity, seed shattering still posses the biggest problem in the production of evening primrose. This project was an agronomic procedure aimed at optimising the appropriate harvest time and harvest method that will lead to higher quality and quantity seed (in aspect of seed yield, oil and γ-linolenic acid percentage). Experience has shown that defoliation before harvest usually accelerates seed ripening and increases the homogeneity of seed maturation. The harvest method used in these experiments was defoliation by means of flame and by chemical. To date our knowledge is still limited about the effect of fertilizers (especially nitrogen) on seed yield and the percentage of oil of evening primrose seed. In this project, the effect of nitrogen under different harvest methods was studied by using some pot experiments.
The effect of storage conditions on the seed oil percentage and fatty acid composition of evening primrose were also investigated. In addition to these seed germination ability of evening primrose was also studied. For field experiments seed yield, thousand seed weight, oil percentage, raw protein percentage, fatty acid composition, plant dry matter, seed dry matter were measured. The parameters measured in the pot experiments were seed yield, thousand seed weight, oil and raw protein percentage, fatty acid composition, number of side shoots per pot, number of capsules per side shoot, number of capsules per main stem and total number of capsules per pot.
Both in field and pot experiments it was observed that harvest time had influence on the seed yield of evening primrose. Due to low maturity, a significant reduction in the seed yield of early harvested plants was observed. Similar pattern of seed yield was observed in plants that were harvested late. Contrary to early harvest high seed shattering is the main reason of low seed yield in the plants that were harvested at the late date. Oil and γ-linolenic acid percentage of the seed were significantly influenced by different harvest times. Low seed maturity at the early time and advance senescence of the seed during the over ripened period are the main reasons for the low percentage of oil. Regardless of the sowing time, in both field as well as pot experiments, it was observed that in most cases the maximum seed quantity and quality was achieved during the middle harvest time.
Despite the above interpretation of results, it is not easy to say how many days after flowering can be recommended as harvest time. The parameters such as plant variety, climate conditions, soil fertility, sowing time, etc. strongly influence harvest time. Generally, according to this study the average of the period after flowering to harvest in autumn and spring sown plants is different. In addition, nitrogen can influence this period. In total, 70-75 days after flowering is the recommended harvest time of the spring sown Oenothera biennis L. cv. Anothera in Germany. In autumn sown plants, the duration between flowering and harvest is longer than spring-sown plants (90-95 d after flowering). Study on the effect of nitrogen on the evening primrose in pot experiments showed that although nitrogen had negative influence on the percentage of seed oil, there was positive relationship between nitrogen and most measured parameters especially seed yield, linoleic and γ-linolenic acid percentage. There is a need to carry out further investigation on the effect of nitrogen as well as other plant nutrients on evening primrose in the field conditions.
In general based on obtained results it can be concluded that in both field and pot experiments no clear effect of defoliation was observed on the different measured parameters like seed yield, the percentage of oil and γ-linolenic acid. The observations of these experiments in most cases do not confirm the hypothesis in which defoliation reduces the heterogenity of seed ripeness and effects seed yield and seed quality. In most cases no interaction between method of harvest and harvest time as well as nitrogen fertilizer was observed. The hypothesis in which effect of defoliation depends on harvest time and nitrogen application is different was not agree with the results obtained.
the results of experiments, it can be concluded that there is not a big difference in the seed yield and seed oil quality of spring and autumn evening primrose. Thus, the hypothesis that the performance of spring-sown evening primrose is equal to autumn sown plants was confirmed with the obtained results.
results showed that the quality of newly harvested seeds of evening primrose gradually decrease during storage. The free fatty acid percentage and the peroxide value of stored seeds strongly increased with the storage time. It was observed that the increase was lower in the seed samples that were stored at low temperature than under room temperature and higher. A negative relationship between storage time and the percentage of oil was observed in this study. Based on the results obtained from the present study, it may be said that for oil quality and quantity the fresh seeds of evening primrose can be stored for a period of 4-6 months.
Temperature is the main factor affecting the germination of evening primrose seeds. A synergetic effect between light and temperature on evening primrose seed germination was observed in this study. Depending on harvest time a gradual increase in the seed germination percentage of newly harvested seed could be achieved by removing the physiological dormancy of embryo during storage. The reduction of germination with increasing storage time could be due to some stimulation of secondary dormancy in the embryo. Die Nachtkerze besitzt als Nutzpflanze ein großes Potential für die kommerzielle Produktion von Gamma-Linoleinsäure. Bei der Kultivierung dieser Pflanze müssen jedoch einige Probleme wie indeterminiertes Wachstum, hoher Samenausfall während der Reife, langer Lebenszyklus und ungleichmäßige Samenabreife gelöst werden. Obwohl sich bereits einige Studien mit der Verminderung des Samenausfalls wie auch der Reduzierung der Blühheterogenität beschäftigt haben, ist der Samenverlust immer noch das größte Problem in der Nachtkerzenproduktion. Das Ziel der Arbeit bestand deshalb darin, in Feld- und Gefäßversuchen den Einfluss unterschiedlicher Erntetermine und Methoden auf den Samenertrag und die Samenqualität von Nachtkerze zu klären. Als Erntemethoden wurden dabei die chemische Sikkation und die thermische Behandlung der Pflanzen angewandt. Parallel zu den Feld- und Gefäßversuchen mit Nachtkerze wurde der Effekt der Lagerungsbedingungen auf den Ölgehalt und die Fettsäurezusammensetzung untersucht. Zusätzlich wurden Experimente durchgeführt, in denen Einflüsse der Erntemethode und der Lagerung auf die Keimfähigkeit der Samen untersucht wurden. In den Feldversuchen wurden die Prüfmerkmale Samenertrag, Tausendkornmasse, Ölgehalt, Proteingehalt, Fettsäurezusammensetzung sowie Ganzpflanzen- und Samentrockenmasse ermittelt. In den Gefäßversuchen wurden die Prüfmerkmale Samenertrag, Tausendkornmasse, Ölgehalt, Proteingehalt und Fettsäurezusammensetzung sowie Anzahl der Seitentriebe pro Gefäß, Anzahl der Kapseln pro Seitentrieb, Anzahl Kapseln pro Haupttrieb und Anzahl Kapseln pro Gefäß bestimmt.
Ergebnisse der Feld- und Gefäßversuche bringen zum Ausdruck, dass der Erntezeitpunkt einen gesicherten Einfluss auf den Samenertrag der Nachtkerze hat. Auf Grund der verringerten Zeit für die Samenreife war der Samenertrag der früh geernteten Pflanzen stark reduziert. Eine Verminderung des Samenertrages wurde auch bei den Pflanzen der letzten Erntezeit gefunden. Im Gegensatz zur frühen Ernte ist bei der späten Ernte der hohe Samenausfall der Hauptgrund für den geringen Samenertrag. Öl- und Gamma-Linoleinsäuregehalt der Samen wurden ebenfalls signifikant durch die verschiedenen Erntetermine beeinflusst. Geringe Ausreife der Samen bei früher Ernte und erhöhte Seneszenz der Pflanzen während der Überreife sind die Hautursachen für den geringen Ölgehalt. Sowohl in den Feld- als auch in den Gefäßexperimenten wurde unabhängig von Frühjahrs- oder Herbstaussaat festgestellt, dass in den meisten Fällen die höchsten Samenerträge und die beste Samenqualität bei mittlerer Erntezeit erzielt wurde. Der Reifetermin der Pflanzen wird durch Faktoren wie Sorte, Witterung, Nährstoffversorgung und Saatzeit signifikant beeinflusst. In den durchgeführten Versuchen wurde festgestellt, dass die Zeitspanne von der Blüte bis zur Ernte bei Frühjahrs- und Herbstaussaat der Nachtkerze verschieden ist. Auch die Stickstoffversorgung hat einen Einfluss auf diese Zeitspanne. Bei einer Aussaat im Frühjahr erreichte die Nachtkerze etwa 70 75 Tage nach der Blüte die Samen- und Erntereife. Bei der Herbstaussaat betrug dieser Zeitraum etwa 90 95 Tage.
Die Erntemethode hatte in den meisten Fällen keinen gesicherten Einfluss auf die gemessenen Parameter. In der Tendenz scheint die Sikkation der Pflanzen, speziell mit einem Herbizid, die Samenreifung zu stimulieren und die Anzahl reifer Samen zu erhöhen. Somit kann diese Maßnahme indirekt den Samenertrag und die Samenölqualität beeinflussen.
Die Untersuchungen zur Stickstoff-Düngung in Gefäßversuchen zeigten, dass dieser Nährstoff einen negativen Einfluss auf den Samenölgehalt, jedoch einen positiven Einfluss den Samenertrag sowie auf den Linolsäure- und Gammalinoleinsäuregehalt der Samen hatte. Zur Validierung dieser Effekte sind jedoch weitere Untersuchungen erforderlich.
Die Ergebnisse der Nachernteexperimente zeigen, dass die Qualität der frisch geernteten Samen der Nachtkerze während der Lagerung allmählich abnimmt. Die Säure- und Peroxidwerte der gelagerten Samen steigen während der Lagerung stark an. Es wurde festgestellt, dass der Anstieg dieser Werte in den Samen bei kühler Temperatur niedriger war als bei Raumtemperatur oder noch höheren Temperaturen. Zwischen Lagerungsdauer und Ölgehalt wurde ein negativer Zusammenhang gefunden. Basierend auf den ermittelten Ergebnissen und im Hinblick auf den Ölgehalt und die Ölqualität kann gesagt werden, dass frisch geerntete Samen der Nachtkerze unter kühlen Bedingungen 4-6 Monate gelagert werden können. In Anlehnung an die Ergebnisse der Versuche zur Keimfähigkeit kann festgestellt werden, dass die Temperatur den Haupteinflussfaktor auf die Keimfähigkeit der Nachtkerzensamen darstellt. Zwischen Licht und Temperatur wurde ein synergistischer Effekt auf die Samenkeimung der Nachtkerze beobachtet. In Abhängigkeit von der Erntezeit konnte ein gradueller Anstieg im Anteil gekeimter Samen während der Lagerung festgestellt werden. Diese wird auf eine Verminderung der Dormanz des Embryos während der ersten Monate der Lagerung zurückgeführt. Bei Langzeitlagerung (Raumtemperatur) von mehr als 6 Monaten nahm die Keimfähigkeit der Samen dagegen ab.
... Gamma-linolenic acid (GLA, 6,9,12octadecatrienoic acid) is an important intermediate in the biosynthesis of biologically active prostaglandin from linolenic acid. GLA has been reported to be effective for the prevention or curing of cardiovascular diseases (10), hypercholesterolemia (11), menstrual disorders (16), for applications in curing certain skin-related (19), as well as a variety of other diseases (3). ...
As a relatively prolific producer of GLA, the strain of Mucor sp LB-54 was selected for a study at different growth temperatures in shaker flask culture. The strain used in our experiment was capable to accumulate a relatively high amount of intracellular lipid, 20.73 % of dry cell weight, and GLA content of 15 % of total fatty acids after 5 days of incubation at 28°C. As the growth temperature was decreased from 28 to 12°C the percentage of GLA increased from 15 to 24 % of total fatty acids. In order to optimize the culture conditions for rapid biomass production and lipid production with a high proportion of GLA, the fungus was grown at two temperature combinations associated supplies of carbon source (glucose) in the culture medium. Maximal production of GLA (74 mg/l) was obtained from the Mucor sp LB-54 strain after 5 days of incubation at 28°C in basal medium following glucose addition (7 % w/v) and incubation for an additional 3 days at 12°C. The identity of GLA found in the strain of Mucor sp LB-54 was confirmed by the coupled gas chromatography-mass spectrometry
Many women with premenstrual syndrome (PMS) use alternative therapies, although the literature on their effectiveness is scarce. PMS is a cyclical condition that causes physical and psychological discomfort related to menstruation. Evening primrose oil has been one of the methods traditionally used to treat different types of inflammation. This characteristic is attributed to its high content of gamma linolenic acid. The objective of this bibliographic review is to evaluate the effectiveness of evening primrose oil for the relief of premenstrual symptoms. A structured research was performed in different databases. Original studies and systematic reviews were selected. Studies from different parts of the world were included to broaden the multicultural nature of the study. No date limit was established in the search in order to have as much information as possible. Finally 8 articles were selected. The results obtained were contradictory, since some studies reported an improvement in the duration and severity of symptoms and others reported no difference compared to placebo. More research is needed to better understand the effects of evening primrose and to obtain a treatment based on the best possible evidence.
Omicron is currently shaking the world to its core. The disease is mainly transmitted via the respiratory route
when people inhale droplets and small airborne particles (that form an aerosol) that infected people exhale as they
breathe, talk, cough, sneeze, or sing. “UK becomes first country in Europe to pass 1,50,000 COVID deaths Omicron
clouds forecasts for Covid end game.Omicron is a variant of nSARS-CoV-2 that has been identified initially in COVID19 patients in Botswana and South Africa. The chief of the World Health Organization (WHO), Tedros Adhanom
Ghebreyesus, has said that the combination of Delta and Omicron variants of coronavirus is driving a tsunami of
COVID-19 cases. The statement came as record new cases were reported from the United States and countries
across Europe. France recorded the highest ever daily numbers in Europe for the second consecutive day, at
208,000 new cases.Vaccines offer strong protection from serious illness.
Premenstrual syndrome is a complex disorder in which a variety of symptoms can occur in the luteal phase of the menstrual cycle. The symptoms should occur each cycle only from the time near ovulation to soon after the onset of menses. There should be at least 1 week in follicular phase that is symptom-free. Symptoms should be severe enough to significantly interfere with the ability of the patient to function within her normal lifestyle. Diagnosis is based on clinical information from prospective charting of symptoms. Up to 50 per cent of patients who think they have PMS really suffer from another type of mental illness, usually a depressive disorder. Laboratory tests, are not generally helpful in the diagnosis. Treatment is based on the type(s) of symptom(s). Available treatments are reviewed with documentation of results from double-blind placebo-controlled experimental designs. The etiology of PMS is not known. However, there are good empiric therapies available that can help most PMS patients.
Analyser les tendances actuelles en ce qui a trait à la prise en charge des femmes qui connaissent des douleurs mammaires.
Evidence for the phytoestrogen containing plants for the treatment of menopausal symptoms was examined in part 1 of this review. Phytotherapeutic agents that may exert estrogenic effects via different mechanisms, and non-hormonally-acting remedies administered for menopause-related complaints in the Anglo-American tradition are reviewed here. The evidence presented is derived from pharmacological and clinical studies.
Evening primrose oil is a popular complementary treatment for the symptoms of premenstrual and menopausal symptoms. • Controlled clinical trials consistently demonstrate that evening primrose oil is no better than placebo in treating such symptoms. • The oil is a rich source of gamma-linolenic acid (GLA), which is useful for general health.
The human female menstrual cycle is marked by the regular occurrence of menses appearing on average once every 28 days starting at puberty and ending at menopause. It is controlled by the endocrine system and requires adequate hormonal and nutritional status to function. Since the menstrual cycle is dependent on the synchronized operation between systems inputs and outputs, disturbances or system failures can occur at any point. Menstrual cycle discomfort or distress ranges from clinically defined and physiologically measurable symptoms of, for example, amenorrhea to the more difficult to measure premenstrual dysphoria. Symptoms of premenstrual discomfort or dysphoria, commonly referred to as premenstrual distress, premenstrual syndrome, or premenstrual dysphoric disorder, are physiological, behavioral, and psychological in nature, commonly experienced and can range in severity from mild to debilitating. Although premenstrual disturbances have been studied extensively by researchers from many disciplines, no consensus on its etiology exists. Nevertheless, psychological, behavioral, physiological, endocrine, and nutritional factors have all been identified as relevant in either their contribution causally or as effective in the treatment of these premenstrual dysphoric disorders. The evidence of links between biochemical, nutritional, and psychological variables and the premenstrual phase of the menstrual cycle are explored in this chapter. Nutritional interventions for premenstrual disorders are catching up with the previously extolled pharmacological therapies, but their efficacy is also yet to be confirmed.
Evening primrose oil, which includes GLA, is one of the most popular of many treatments available for PMS. It has been reported that diagnosis of PMS on the basis of prospective daily rating is essential. However, few studies on alleviation by GLA of the symptoms of PMS have been performed using prospective daily rating. We examined the alleviating effect of GLA on symptoms of PMS diagnosed by prospective daily rating. Twenty-eight women diagnosed with PMS consumed vegetable oil containing about 180 mg/day of GLA for three luteal phases in a randomized, double-blind, parallel protocol, and were examined for duration and severity of PMS symptoms. Levels of DGLA in plasma phospholipid were significantly lower in women with PMS than in those without it (DGLA, P < 0.01) before treatment regardless of phase in menstrual cycle. After GLA administration, the levels of GLA and DGLA in plasma phospholipid in the GLA group were significantly higher than those both in the placebo group and before treatment. Improvement of the duration and severity of PMS symptoms as a whole, as well as that of irritability, was significantly more pronounced in the GLA than in the placebo group. These findings indicate that GLA can be effective for treating the symptoms of PMS, and that GLA and DGLA in plasma phospholipid may play a role in the onset of PMS.
In this study, we investigated the effects of bright light therapy on the symptoms of depression, anxiety, and hibernation in patients with premenstrual syndrome (PMS). Ten women with prospectively documented PMS underwent a crossover trial of bright light (> 2,500 lux) either in the morning or in the evening during the premenstrual phase of two different menstrual cycles. The results of the Hamilton Rating Scale for Depression (HRSD) before and after treatment were divided into depression, anxiety, and hibernation categories. We found that evening light significantly reduced the symptoms of depression. Light treatment tended to reduce both anxiety and hibernation ratings, but this decrease was not statistically significant. Although further control studies using different placebo conditions are warranted, our initial results are promising with regard to the potential antidepressant effects of light.
Fatty acids in plasma phospholipids were measured in two groups of women with premenstrual syndrome, two groups with cyclical breast disease and two groups with non-cyclical breast disease and were compared with two groups of normal controls. All the patient groups showed similar abnormalities which made them different from both sets of controls. Concentrations of the main dietary n — 6 essential fatty acid (EFA), linoleic acid, were consistently higher in the patients than in the controls, whereas levels of linoleic acid metabolites were consistently lower. This suggests that these patients have an abnormality in EFA metabolism, probably involving reduced conversion of linoleic acid to its EFA products. Concentrations of the n — 3 EFAs were for the most part near normal, with a tendency to elevation in premenstrual syndrome and to reduction in non-cyclical breast disease.
Discusses the etiology, diagnosis, and treatment approaches for premenstrual syndrome (PMS). While the etiology remains a mystery, possible biologic causes include hypoglycemia, abnormalities of gonadal steroids, and allergies to endogenous hormones; most psychological etiologies are derived from the psychoanalytic school. Approaches to treatment are multiple, with most successes being reported anecdotally. Common treatments include (1) the use of drugs, such as tranquilizers and antidepressants; (2) the use of lithium salts and/or diuretics, prostaglandin inhibitors, or antifungal treatments; (3) administration of natural progesterone or of danazol, an antigonadotropin; (4) abdominal hysterectomy and bilateral oophorectomy; (5) nonmedical methods, such as support groups; and (6) self-treatment, such as exercising. A biopsychosocial approach is recommended. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Fatty acids in plasma phospholipids were measured in two groups of women with premenstrual syndrome, two groups with cyclical breast disease and two groups with non-cyclical breast disease and were compared with two groups of normal controls. All the patient groups showed similar abnormalities which made them different from both sets of controls. Concentrations of the main dietary n — 6 essential fatty acid (EFA), linoleic acid, were consistently higher in the patients than in the controls, whereas levels of linoleic acid metabolites were consistently lower. This suggests that these patients have an abnormality in EFA metabolism, probably involving reduced conversion of linoleic acid to its EFA products. Concentrations of the n — 3 EFAs were for the most part near normal, with a tendency to elevation in premenstrual syndrome and to reduction in non-cyclical breast disease.
Stress is frequently associated with the prementrual syndrome. In many women there is an underlying increased stress level so that the physiological premenstrual symptoms with which they could normally cope considerably affect their life styles; this is secondary premenstrual syndrome. In others, stress is part of the symptomatology of their primary premenstrual syndrome; they are free from stress at other times. Appropriate management for these two groups of women differs and is discussed.
Pharmaceutically important γ-linolenic acid (GLA) was produced (4.1mgg−1 dry wt) by laboratory grown cyanobacterium Fischerella sp. colonizing Neem (Azadirachta indica) tree bark. GLA isolated from the test cyanobacterium was active against Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 25992, Salmonella typhi (local strain), Pseudomonas aeruginosa ATCC 27853 and Enterobacter aerogenes MTCC 2822. The overproduction of GLA was also monitored by altering phosphate and nitrate levels in the nutrient medium.
A doubling in phosphate concentration (58μM) increased GLA level up to 12% over that of control cells while half of this phosphate level reduced GLA synthesis by 8%.
In contrast, elevated nitrate concentrations (5 and 10mM) stimulated biomass yield but not GLA, as the levels approximated
to the nitrate-lacking control. The antibacterial potential of GLA from Fischerella sp. grown at varying P or N levels was at variance as evidenced by the diameter of inhibition zones against S. aureus. This variation in inhibition zones reflected differing levels of GLA as ascertained quantitatively by HPLC.
The triacylglycerol stereospecific structure was determined for the major plant oils containing ψ-linolenic acid (GLA): evening
primrose oil (EPO), black currant oil (BCO), borage oil (BO), andMucor javanicus fungal oil (MJO). It was found that GLA, although not α-linolenic acid, resisted pancreatic lipase hydrolysis. Therefore,
the 2-position analysis was determined using phospholipase C-generated 1,2-diacylglycerol and phospholipase A2-generated lysophosphatidylcholine. GLA was found to be concentrated in the 3-position of EPO and BCO, the 2-position of BO,
and the 2- and 3-positions of MJO. In BCO, octadecatetraenoic acid (n−3), also a †-6 fatty acid, was distributed similarly
to GLA, but α-linolenic acid was found predominantly in the 1-position. Linoleic acid was nearly evenly distributed in all
positions of EPO and BCO but was concentrated in the 1-position of BO and the 2-position of MJO. Both palmitic and stearic
acids were found predominantly in the 1-position of all of the oils. The results demonstrate similarities and differences
in the positional distribution of fatty acids in GLA-containing oils.
The premenstrual syndrome has been described briefly and the literature relating to its pathophysiology and treatment have been reviewed. The great number of theories as to etiology and many different kinds of treatments attest to our ignorance of the exact nature of this problem. Although it is obvious that the hypothalamo-pituitary-ovarian axis must be involved, the exact mechanism whereby the symptoms come about remains elusive. Progestin in the presence of estrogen appears to be essential. Excess estrogen may aggravate the condition. The popular theory of progesterone deficiency has not been supported by double blind trials of progesterone in various forms versus placebo. Because of the important placebo effect in this condition, double blind trials are essential in the assessment of any form of treatment.
Three categories of treatments for premenstrual syndrome (PMS) have been proposed: those designed to correct the cause of the disorder; those designed for symptom relief; and those aimed at eliminating the menstrual cycle. Many of these recommendations are based on poor research with loose definitions of the disorder and uncontrolled open trials. This paper reviews the literature on treatment methods with emphasis on recent random, placebo controlled, double-blind studies. The most effective current management of PMS is a conservative one including accurate diagnosis, stress control, sensible levels of diet and exercise and perhaps the use of alprazolam in the premenstrual period. Other approaches such as the use of mefenamic acid and evening oil of primrose remain unproven. Progesterone has been proven uneffective. Further research is required into the value of antidepressant medication.
Premenstrual syndrome (PMS), a constellation of physical and psychologic symptoms, is a common complaint among women of reproductive age, particularly women in their 30s or older and among women of greater parity. Symptoms must occur in the luteal phase with resolution or improvement within one or two days of the onset of menses. Numerous hypotheses have been espoused to explain the etiology of PMS, but no definitive cause has been established. The management of PMS may include simple measures such as exercise, dietary changes, and vitamin supplementation. Pharmacologic agents such as progesterone, prostaglandin inhibitors, diuretics, oral contraceptives, or psychotropic drugs may be useful in selected clients. Support and counseling is of paramount importance in the management of PMS. Nurse-midwives can manage women who have minor and transient physiologic and emotional changes associated with mild degrees of PMS. Women with moderate and severe symptoms should be referred for evaluation and follow-up.
A daily record of five physical symptoms was kept by 44 women self-selected as having the premenstrual syndrome (PMS+ group, 133 menstrual cycles) and 48 women self-selected as not having PMS (PMS- group, 100 cycles). Symptoms were analysed after fitting the first five terms of a Fourier series. PMS+ women differed significantly from PMS- women in (i) the incidence of significant physical symptom swings (present in 81.2% vs 33.0% of cycles), (ii) the incidence of significant physical symptoms in the premenstruum (PMT: present in 80.5% vs 24.0% of cycles), and (iii) PMT severity (mean +/- SE, 1.37 +/- 0.08 vs 0.27 +/- 0.04). Pregnanediol excretion and the distribution of stomach cramps were similar in the two groups. The small but significant symptom increase observed in the premenstruum of PMS-women is consistent with the view that premenstrual physical symptoms, unlike premenstrual psychological symptoms, may be associated with the normal menstrual cycle. For confirmation more evidence is required.
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