PMS: How can my premenstrual syndrome be treated?

J Affect Disord. 2005 Apr;85(3):317-21.

Luteal phase treatment of premenstrual dysphoric disorder improves symptoms that continue into the postmenstrual phase. Yonkers KA , Pearlstein T , Fayyad R , Gillespie JA .

Kimberly.Yonkers@Yale.edu

Background:

Despite the proven efficacy of luteal phase medication dosing for women with premenstrual dysphoric disorder (PMDD), it is not known whether this approach adequately treats symptoms that linger into the first 2-3 days of the follicular phase, a time when up to one-third of women diagnosed with PM report residual symptoms. Furthermore, no previous study has explored whether abruptly stopping medication after 2 weeks of treatment is associated with discontinuation symptoms.

Methods:

To evaluate the efficacy of luteal phase medication dosing, symptom data from the Daily Record of Severity of Problems (DRSP) during first few days of menses were compared from two studies with similar designs but different treatment strategies. The first study used continuous dosing of sertraline, 50-150 mg/day, throughout the menstrual cycle, while the second study used intermittent dosing with sertraline, 50-100 mg/day in the 14-16 days prior to onset of menses. To investigate whether abruptly stopping pills led to discontinuation symptoms, DRSP data for the first 5 days after the onset of menses were analyzed in the second (intermittent dosing) study. Symptom scores were compared for subjects who took either sertraline or placebo premenstrually and ceased taking pills at the onset of menses.

Results:

The baseline (pretreatment) to on-treatment effect sizes were similar for continuous vs. luteal phase dosing on the first day of menses (0.73 vs. 0.89), second day of menses (0.40 vs. 0.55), and third day of menses (0.42 vs. 0.44), respectively. Subjects who abruptly discontinued sertraline had fewer symptoms indicative of withdrawal at Day 3 (p< 0.01) and no difference during Days 4-5 compared to subjects abruptly discontinuing placebo.

Conclusion:

Patients given active medication during the luteal phase demonstrate reductions in DRSP total scores into the first few days of menses regardless of whether active treatment was continuous throughout the menstrual cycle or was discontinued at the onset of menses. This analysis finds no support for discontinuation symptoms following abrupt cessation of sertraline after 2 weeks of treatment for two cycles.

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• 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?
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