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Bromocriptine in the treatment of premenstrual tension syndrome.

Twenty-four women with regular cycles who reported moderate to severe premenstrual tension participated in a double-blind study to test the effectiveness of CB154 on the control of their symptoms. Symptoms were scored daily and were further evaluated objectively twice monthly by physical examination. Control cycle follicular/luteal delta weights were not different statistically from a 0 change (P > .10), despite long-standing symptoms of bloating, swelling, and reported weight gain. CB154 treatment resulted in statistically significant improvement in daily ratings of breast tenderness (P < .005), bloating (P < .02), and depression (P < .05). Significant placebo effects observed for several other symptoms emphasize the psychologic component of this condition as well as the need for caution in the interpretation of any uncontrolled trials for therapies thought effective in the treatment of this disorder.

Adolescent↗

Premenstrual tension syndrome with periodic bulimia nervosa: report of a case and review of the literature.

Premenstrual tension syndrome (PMS) is well known in its epidemiology, etiology, symptomatology and treatment. However, PMS characterized by bulimic episodes is rare. We report a case of a 20-year-old university student who suffered from uncontrollable binge eating premenstrually for six months before visiting our clinic. She was obese without any other notable family or medical history except the PMS noted for two years. A daily food diary for two consecutive menstrual cycles showed that the mean differences in caloric intake between premenstrual and postmenstrual days of two menstrual cycles were 679 and 703 calories, respectively. The greater peaks in caloric level were noted within the third to fifth days prior to the onset of menstruation. All binge episodes occurred in the premenstrual period, especially within five days prior to menstruation. In this report, we will also review the literature on the relationship between PMS and dietary intake, as well as bulimia nervosa.

Adult↗

Assessment of the significance and severity of premenstrual tension--I. A new model.

A method is proposed for analysing daily mood scores for premenstrual tension (PMT) in single menstrual cycles by fitting an approximation function consisting of the first two harmonics of a Fourier series. On the basis of harmonic analysis of 133 cycles of daily mood scores obtained from women perceiving themselves to have the premenstrual syndrome (PMS), the severity of PMT is taken to be the difference between the mean and the fitted function at a point 92% of the way through the menstrual cycle. The significance of the severity is calculated statistically. Significant PMT was detected in 70% of the 133 cycles; this compared with an 8% incidence in women who considered that they did not have PMS. The method improves on previously described methods for detecting PMT by: (1) using statistical criteria; (2) modelling cycles with asymmetric and double peaks; (3) using a difference rather than a ratio as the severity estimate; (4) smoothing the data and (5) giving valid estimates when data points are missing. There was no evidence for the presence of distinct periodicities with wavelengths less than half that of the menstrual cycle.

Adolescent↗

Plasma copper, zinc and magnesium levels in patients with premenstrual tension syndrome.

We measured plasma Cu. Zn and Mg levels in 40 women suffering from premenstrual tension syndrome (PMTS) and in 20 control subjects by atomic absorption spectrophotometer. Mean plasma Cu, Zn and Mg levels, the Zn/Cu ratio were 80.2 +/- 6.00 micrograms/dl, 112.6 +/- 8.35 micrograms/dl, 0.70 +/- 0.18 mmol/l, and 1.40 +/- 0.10 in the PMTS group; and 77.0 +/- 4.50 micrograms/dl, 117.4 +/- 9.50 micrograms/dl, 0.87 +/- 0.10 mmol/l, and 1.51 +/- 0.05 in the control group respectively. The mean Mg level and the Zn/Cu ratio were significantly lower in PMTS patients than in the control group. Plasma Mg and Zn levels were diminished significantly during the luteal phase compared to the follicular phase in PMTS group. Mg deficiency may play a role in the etiology of PMTS.

Copper↗

Premenstrual tension syndrome: the development of research diagnostic criteria and new rating scales.

Research diagnostic criteria for premenstrual tension syndrome (PMTS) are developed using data collected from a study of 42 women who were suffering from severe PMTS but were well at other times. Two specific scales are also devised for rating the severity of PMTS, a 36-item self-report questionnaire and a 10-item scale for use by therapist/researcher. It is proposed that after further evaluation and validation, these instruments may permit more useful comparisons of data on the etiology and treatment of this disorder.

Adult↗

The incidence of premenstrual tension in a gynecologic clinic.

A menstrual symptom questionnaire was used to assess the incidence of premenstrual tension (PMT) in 1,395 regularly menstruating women not on hormonal contraceptives or any other hormonal therapy during routine visits to a gynecologic clinic. Nineteen symptoms were divided into four PMT subgroups: PMT-A (anxiety, irritability, mood swings, nervous tension), PMT-H (weight gain, swelling of extremities, breast tenderness, abdominal bloating), PMT-C (headache, craving for sweets, increased appetite, heart pounding, fatigue and dizziness or fainting) and PMT-D (depression, forgetfulness, crying, confusion, insomnia). The ages of the patients ranged from 13 to 54 years, with a mean +/- S.D. of 32 +/- 8.5 years. Using strict criteria for PMT, 702 patients scored positive for at least one subgroup of PMT, giving an incidence of 50%. When the patients were divided into five-year age groups, a peak incidence of 60% was observed in the third decade of life. The most common PMT subgroups were PMT-A and PMT-H, occurring either alone or in combination. The least common subgroup was PMT-D, occurring in only 12 patients and by itself. The mean cycle length in pure PMT-D patients was significantly shorter (p less than 0.05) than in patients without PMT.

Adolescent↗

Plasma prolactin and severe premenstrual tension.

It has been suggested that elevated luteal phase prolactin (PRL) levels may have an important role in causing some of the symptoms of the premenstrual tension syndrome (PMTS). Thirty-seven women suffering from severe premenstrual dysphoria were selected for this study. Single morning and afternoon serum PRL evaluations were performed during the follicular (day 9) and late luteal (day 26) phases of the menstrual cycle. PRL was measured by an established double antibody radioimmunoassay technique. All mean PRL values were within the normal range. Only afternoon mean PRL levels showed a tendency for a premenstrual increase. The significance of this statistical finding is unclear, since one-third of the subjects showed a decrease in premenstrual PRL levels. Twenty-four hour PRL secretory profiles recorded on days 9 and 26 in two women with extremely severe PMTS and in two asymptomatic matched control subjects also failed to show a significant correlation between PRL levels and PMTS. Thirty subjects participated in a treatment trial using bromocriptine. A marked rebound hyperprolactinemia was observed in a subgroup of women nine days after cessation of bromocriptine. This was associated with no detectable effect on mood, behavior, or menstrual regularity. Thus, our data fail to show any specific relationship between PRL and PMTS.

Adult↗

Role of nutrition in managing the premenstrual tension syndromes.

The clinical, biochemical and endocrine effects of a total dietary program were evaluated in patients with the premenstrual tension syndromes (PMTS). The program consisted of dietary guidelines and nutritional supplementation. Open trials suggested that an initial dosage of the supplement consisting of six tablets daily gave the best symptomatic relief during the first three to six months. Double-blind studies confirmed that a daily average of six tablets decreased PMTS symptom scores to significantly lower levels than did the placebo. A significantly higher percentage of PMTS patients reported feeling better on the dietary program than did those on the placebo. Although significant changes were observed in some liver function tests, the values were within the normal ranges. The dietary program, implemented for three to six months, decreased serum estradiol 17-beta and increased serum progesterone levels during the midluteal phase in PMTS patients. Nonresponders using the program should be reevaluated and treated according to the results of the reevaluation and the PMTS symptoms.

Acne Vulgaris↗

Treatment of premenstrual tension with lithium carbonate. A pilot study.

Some previous reports have suggested that lithium treatment is of benefit to women with the premenstrual tension syndrome (PMTS). In this study 15 women carefully selected for severe PMTS were given lithium carbonate (600-900 mg/day) continuously for three menstrual cycles. Lithium did not affect physical premenstrual symptoms and was ineffective in most women against behavioral premenstrual symptoms. Despite the low dosage most women also experienced significant drug-related side effects. Although a statistically significant improvement was recorded by several symptom rating instruments, this benefit was of no practical clinical value. The three women who responded best to lithium, and who requested continued treatment beyond 3 months, met diagnostic criteria for subsyndromal affective (cyclothymic) disorder. Lithium is not recommended for the average woman with PMTS.

Adult↗

Hormonal studies in women with premenstrual tension.

Serum hormone concentrations were determined at intervals during the last 17 days of the menstrual cycle in 35 patients with premenstrual tension (PMT) and 11 control subjects without symptoms. The maximum mean concentration of oestradiol occurred 17 days before menstruation in the patients and 14 days before in the controls. The maximum concentrations of progesterone were similar in the two groups but the mean concentrations rose earlier in the cycle in the patients with PMT. These results suggested that the patients tended to ovulate earlier in the cycle than the controls and on the basis of the ovulatory surge in gonadotrophins two groups could be identified, group A who showed signs of ovulation 14 days or less before menstruation (17 patients, 9 controls) and group B who ovulated more than 14 days before menstruation (18 patients, 2 controls). There were no significant differences between the groups in prolactin, thyroid stimulating hormone or testosterone levels, but cortisol concentrations were uniformly higher in both groups of patients compared with those in the controls. Follicular growth was assessed with ultrasound in 18 patients and 16 control subjects. Mean follicular diameters were significantly lower in the patients than in the control group at the time of ovulation. Oestradiol determinations done at the same time correlated with the diameters and were also significantly lower in the patient group. The results suggest that ovulation tends to occur prematurely in women with PMT.

Adult↗

Hormone profile in premenstrual tension: effects of bromocriptine and diuretics.

Plasma levels of prolactin, FSH, LH, progesterone and 17-beta-oestradiol in twenty women with premenstrual tension were compared with those in twenty controls. The former group was studied also during treatment with bromocriptine. The mean prolactin level in the PMT group was lower in the follicular phase than in the luteal phase (P less than 0.01), but there was no difference between the PMT and control group in the luteal phase. No differences were found between the controls and the PMT group in FSH,LH, 17-beta-oestradiol and progesterone levels in the luteal phase. Bromocriptine suppressed prolactin concentrations (P less than 0.01), but had no effect on the FSH, LH, 17-B-oestradiol or progesterone levels.

Adult↗

Plasma beta-endorphin immunoreactivity in premenstrual tension.

Plasma samples were collected twice during the follicular phase and three times during the luteal phase of the menstrual cycle in 12 women with premenstrual tension (PMT) and in 14 control subjects without symptoms. Concentrations of beta-endorphin (beta-E) immunoreactivity, cortisol, oestradiol, progesterone and LH were determined. Comparison of the mean concentrations of LH, cortisol, oestradiol and progesterone did not reveal any statistically significant differences between the PMT and the control groups. In the early luteal phase, the mean plasma beta-E immunoreactivity was lower in the PMT group (10.7, SE 0.7 pg/ml) than in the control group (14.6, SE 1.6 pg/ml, P less than 0.05), suggesting that endorphin secretion is decreased in PMT. No significant change in the plasma beta-E level was found in the PMT patients between the follicular and luteal phase when symptoms appeared. This does not exclude the possibility that in the central nervous system abnormal changes occur in the activity of endogenous opioids in PMT.

Adult↗

Ovarian suppression with the gonadotrophin-releasing hormone agonist goserelin (Zoladex) in management of the premenstrual tension syndrome.

The objective of this study was to determine the effectiveness of ovarian suppression by a GnRH agonist analogue in 32 women with prospectively confirmed severe premenstrual tension. The design was a randomized, double-blind study comparing goserelin 3.6 mg with placebo, both given as a monthly s.c. injection for 3 months. Self-assessment was by daily visual analogue scales (VAS) for anxiety and depression, daily quantitative symptom rating for breast discomfort, swelling, irritability, tension, depression and by monthly Hospital Anxiety and Depression (HAD) scales. Of the 16 women in each group, 15 completed active and 12 completed placebo therapy. Median symptom scores for whole cycles showed a significant reduction of breast discomfort and swelling during active treatment, with no significant improvement in psychological symptoms. Analysis by cycle phase showed that for individual subjects, pre-treatment differences in VAS scores for anxiety and depression were abolished in a significantly greater proportion of actively treated cycles. Within-group comparisons showed a marked placebo effect and, comparing the two groups, differences reached significance only during treatment cycle 1 and the first post-treatment cycle for anxiety with no significant differences for depression. It was concluded that while suppression of ovarian activity with a gonadotrophin-releasing hormone analogue dampens down cyclical mood swings, it has a more marked effect on the physical components of the premenstrual syndrome. Results reconfirm the positive role of placebo in the management of this condition.

Adult↗

Impaired reception of nonverbal cues in women with premenstrual tension syndrome.

The ability to perceive nonverbal facial cues was tested in 30 White, middle-class females. Pre- and post-menses responses of 15 subjects diagnosed as having Premenstrual Tension Syndrome (PMS) were compared to the responses of age-matched controls. Each subject was asked to interpret videotaped facial cues of individuals engaged in a gambling task. Interpretive ability fluctuated during the menstrual cycle and was significantly impaired during the premenstrual phase.

Adult↗

Pre-eclampsia, hypertension and the premenstrual tension syndrome.

A total of 261 of 17,000 pregnancies were complicated by pre-eclampsia/hypertension in pregnancy. Seven to twelve years later 237 were available for follow-up together with 33 women, who had a normotensive pregnancy in 1969-1973. The association between pre-eclampsia/hypertension and the premenstrual tension syndrome has been studied. Women with present hypertension complained significantly (P less than 0.05) more of premenstrual sadness than the normotensive women. However, women with previous pre-eclampsia/hypertension in pregnancy did not have more premenstrual symptoms than women in general, on the contrary, women with a history of severe pre-eclampsia had less symptoms.

Adult↗