Psychoneuroendocrinology. 2003 Aug;28 Suppl 3:39-53.
A review of treatment of premenstrual syndrome and premenstrual dysphoric disorder.
Rapkin A.
UCLA School of Medicine, Department of Obstetrics
and Gynecology, Center for the Health Sciences, Los Angeles, CA
90095-1740, USA. arapkin@mednet.ucla.edu 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.
Please click on the required question.
- Premenstrual Syndrome - PMS What is The Premenstrual Syndrome (PMS)
- 2 How prevalent is PMS?
- 3 How can we tell if I have PMS?
- 4 How can my PMS be evaluated?
- 5 How can cyclical breast pain (mastalgia) be treated?
- 6 How can my PMS be treated?
- 7 What is the place of progestogens and progesterone in the management of PMS?
- 8 Could suppressing my menstrual cycle reduce my PMS problems?
- 9 Could a diuretic help my PMS?
- 10 Is there a place for anti-depressants or anxiolytic drugs in the management of PMS?
- 11 Is there a place for removing my ovaries in the management of PMS?
- 12 What can be done about my decreased libido (sex drive)
- 12A What is the place of Viagra (sildenafil citrate) in sexual dysfunction in women?
- 13 How is PMS treatment monitored?
- 14 How long should PMS treatment be taken?
- 15 What is the chronic fatigue syndrome?
- 16 What is seasonal affective disorder (SAD)
- 17 Where can I obtain more information?
- 18 Support Groups.
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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
