Alternative Therapies for Premenstrual Syndrome
Curing Premenstrual Tension Naturally
Is Moodiness, Pain and Bloating Paralyzing Your Life In the Days Leading Up to Your Period? Just what is premenstrual tension also known as PMS anyway and why does it cause most women so much misery?
The prevalence of mood disorders in women, including premenstrual syndrome (PMS) and post-partum depression, also deserves mention. PMS is a cyclic recurrence of symptoms both somatic (oedema, fatigue, breast tenderness, headaches) and psychological (depression, irritability, and affective lability). The symptoms start following ovulation and disappear within the first day or two of menses, followed by a symptom-free interval between menses and the next ovulation. In some cases (5-10 ), symptoms may be severe enough to interfere with normal functioning, leading to the diagnosis of premenstrual dysphoric disorder (PMDD) 106 . GnRH agonists, which produce a clinical ovariectomy'' by down-regulation of GnRH
Premenstrual syndrome is characterized by mood swings, depressed mood, irritability and or anxiety, which may be accompanied by physical symptoms. These symptoms occur exclusively during the luteal phase of the menstrual cycle. Common physical symptoms observed in PMS are breast tenderness, abdominal bloating, headache, and joint and muscle aches. The diagnosis of PMDD requires marked mood disturbance (depression, irritability, mood swings) as well as the presence of other emotional and or physical symptoms. Additionally, a significant
Patients with mild to moderate premenstrual symptoms have reported that reducing caffeine, refined sugars, or sodium intake can be helpful. Although increased exercise has been found to reduce symptoms of major depressive disorder, there is no definitive evidence that it results in improvement of PMDD symptoms. There are no recent controlled studies to support the anecdotal reports of the benefits of a healthy diet and exercise for premenstrual syndrome. Nonetheless, these interventions are recommended because of their other benefits and safety.
Randomized controlled trials ofVitamin B6, calcium, and carbohydrate-rich dietary supplements have demonstrated efficacy in premenstrual syndrome. A recent meta-analysis revealed that vitamin B6 in daily doses of 50-100 mg reduced premenstrual mood and physical symptoms. Calcium supplementation has also been shown to be efficacious in the management of moderate to severe premenstrual symptoms. A randomized controlled trial comparing calcium carbonate to placebo revealed that 1200 mg of calcium carbonate resulted in a significant reduction of physical (water retention, food craving and pain) and emotional (negative affect) premenstrual symptoms.
Complementary alternative therapies for premenstrual syndrome A systematic review of randomized controlled trials. Am J Obstet Gynecol 2001 185 227-235. 11. Wyatt K, Dimmock P, Jones P et al. Efficacy of progesterone and progestogens in management of premenstrual syndrome A systematic review. BMJ 2001 323 1-8. 12. Wyatt KM, Dimmock PW, Ismail KMK et al. The effectiveness of GnRHa with and without 'add-back' therapy in treating premenstrual syndrome A meta analysis. BJOG 2004 111 585-593.
London Hogarth Press, 1966-1973. Volume 7 in this collection of Freud's works contains a detailed case history of a woman named Dora, whom Freud treated over a period of years. This case history illustrates Freud's ideas about the causes of neurosis and hysterical symptoms. The work also contains three essays on sexuality, including sexual aberrations, infantile sexuality, and puberty. Gilligan, Carol. In a Different Voice. Reprint. Cambridge, Mass. Harvard University Press, 1993. Traditional theories of development have tried to impose male thinking and values on female psychology. Gilligan discusses the importance of relationships as well as female conceptions of morality, challenging Freud's views on female superego development. Horney, Karen. Feminine Psychology. Reprint. Edited by Harold Kelman. New York W. W. Norton, 1993. A collection of some of Horney's early works in which she describes Freudian ideas on the psychology of women and offers her...
Distinguishing the emotional symptoms observed in PMS from those present in other major mood or anxiety disorders (e.g., major depressive disorder, dys-thymia, panic disorder) is important because of the different treatment strategies. Women with PMS respond to unique therapeutic interventions, such as calcium carbonate, gonadotropin releasing hormone agonists and intermittent dosing with serotonin reuptake inhibitors (SRIs). If patients present with continuous mood or anxiety symptoms across the menstrual cycle, the diagnosis of PMS cannot be made. If patients exhibit mood and or anxiety symptoms across the menstrual cycle with an increase in severity during the luteal phase, the appropriate diagnosis is premenstrual exacerbation (PME) of the underlying condition, not PMS. Therefore, diagnostic verification of premenstrual syndrome is best accomplished through prospective daily symptom recording (or charting ). This prospective rating is required to make a diagnosis of PMDD.
Progesterone has also been used for the treatment of premenstrual syndrome, but a recent meta-analysis found that progesterone and other progestogens were no more effective than placebo. In contrast, gonadotropin releasing hormone (GnRH) agonists, including leuprolide and buserelin, were superior to placebo in the reduction of premenstrual emotional (irritability, depression) and physical (bloating, breast tenderness) symptoms in four double-blind controlled studies. Although GnRH agonists may be effective for PMDD, the parenteral route of administration (for leuprolide), cost, and potential side effects, including hot flushes and vaginal dryness, make them a third line treatment strategy.
Alprazolam, a triazolobenzodiazepine anxiolytic agent, has also been studied in the treatment of premenstrual syndrome. Of five randomized controlled trials, four found alprazolam to be more effective than placebo. In positive studies, alprazolam was particularly effective for management of premenstrual anxiety. Clinicians should remain cautious when prescribing alprazolam given its risk of tolerance and dependence.