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At least 19 recordsLinked to original sources
PubMed2004

Premenstrual syndrome, premenstrual dysphoric disorder, and beyond: a clinical primer for practitioners.

The management of adverse premenstrual symptoms has presented a difficult challenge for clinicians. However, based on numerous well-designed research studies over the last decade, we now have diagnostic criteria for the severe form of the syndrome, premenstrual dysphoric disorder, and a variety of evidence-based therapeutic strategies. This review presents a comprehensive, practical description of what the clinician needs to know to diagnose and treat adverse premenstrual symptoms at all levels of severity. Diagnostic criteria are described in detail, including a discussion of the distinction between premenstrual dysphoric disorder and premenstrual syndrome (PMS). The rationale for including prospective symptom calendars as a routine part of the diagnostic evaluation of severe symptoms is presented. The differential diagnosis of cyclic symptoms, including depression and anxiety disorders, menstrual migraine, and mastalgia, and an approach for the management of each of these problems are presented. A treatment approach is recommended that matches the treatment to the degree of problems the woman is experiencing. Serotonin reuptake inhibitors are the treatment of choice for severe symptoms, and most women with PMS/premenstrual dysphoric disorder will respond to intermittent, luteal phase-only therapy. Ovulation suppression should be reserved for women who do not respond to other forms of therapy. The role of oophorectomy is limited, and guidelines for its use are presented.

Decision Trees↗
PubMed2005

Sympathetic skin response in premenstrual syndrome.

Premenstrual syndrome is a term which includes a broad group of emotional, behavioral and physical symptoms that occur for several days before menses and subside following the menstrual period. Many women experience premenstrual syndrome symptoms, particularly physical ones such as breast tenderness and swelling. Approximately 5-10% women suffer from severe premenstrual syndrome and another 30-40% have moderate symptoms. Premenstrual syndrome continues to be an unsolved problem. In this study, we evaluated 24 premenstrual syndrome patients and 20 healthy women in the control group. The ages of the women were 22-34 years (mean +/- SD: 25+/-3) for the premenstrual syndrome group and 23-34 (25+/-3) for the control group. The sympathetic skin response was recorded from the palms, soles and genital regions by using electrical stimuli to the median nerve at the wrist. The sympathetic skin response was recorded twice, in the follicular and late luteal phases of menstruation. The follicular and late luteal phase sympathetic skin response of the two groups were compared. The amplitudes and latency values of the late luteal and follicular phase sympathetic skin response from the premenstrual syndrome group and control group women were statistically similar. We also did not find any latency or amplitude difference in the sympathetic skin response obtained from the three regions of the premenstrual syndrome patients and the control group. We checked sympathetic skin response in the symptomatic (late luteal phase) and asymptomatic (follicular phase) periods of patients with premenstrual syndrome, a disorder known to have many autonomic symptoms, to determine whether there was sudomotor sympathetic involvement. The results of our PMS patients indicate at the very least that there is no difference with the control subjects as regards peripheral sudomotor functions.

Adult↗
PubMed1999

Randomized controlled trial of the management of premenstrual syndrome and premenstrual mastalgia using luteal phase-only danazol.

OBJECTIVE: Our goal was to evaluate the efficacy and side effects of danazol 200 mg daily given only in the luteal phase of the menstrual cycle to treat premenstrual syndrome and premenstrual mastalgia. STUDY DESIGN: We conducted a randomized, double-blind, placebo-controlled study of 3 menstrual cycles in a postgraduate medical school and National Health Service hospital. The subjects of the study were 100 women who had been referred to the premenstrual syndrome clinic at the North Staffordshire Hospital for the management of premenstrual syndrome and premenstrual breast pain. Outcome measures for the study included assessment of improvement in symptoms measured by specific daily visual analogue scales for 4 principal symptoms of premenstrual syndrome and for premenstrual mastalgia and assessment of side effects and adverse events. RESULTS: Significant improvement in symptoms was seen in visual analog scores for mastalgia in months 1 (P =.03), 2 (P =.004), and 3 (P =.01) of the study during active therapy compared with placebo. No improvement was seen for any other symptom or for the global premenstrual syndrome score. Side effects on danazol and on placebo were equal and minimal. CONCLUSIONS: Luteal phase-only danazol is not effective for the treatment of the general symptoms of premenstrual syndrome but appears highly effective for the relief of premenstrual mastalgia. This approach to therapy is associated with few side effects. Studies of cyclic mastalgia using strict diagnostic criteria are required to see whether the freedom from symptomatic side effects is found in longer-term studies and to determine whether such a regimen avoids potentially detrimental effects on the lipid status.

Adult↗
PubMed2003

Premenstrual syndrome.

Premenstrual syndrome, a common cyclic disorder of young and middle-aged women, is characterized by emotional and physical symptoms that consistently occur during the luteal phase of the menstrual cycle. Women with more severe affective symptoms are classified as having premenstrual dysphoric disorder. Although the etiology of these disorders remains uncertain, research suggests that altered regulation of neurohormones and neurotransmitters is involved. Premenstrual syndrome and premenstrual dysphoric disorder are diagnoses of exclusion; therefore, alternative explanations for symptoms must be considered before either diagnosis is made. The disorders can manifest with a wide variety of symptoms, including depression, mood lability, abdominal pain, breast tenderness, headache, and fatigue. Women with mild symptoms should be instructed about lifestyle changes, including healthy diet, sodium and caffeine restriction, exercise, and stress reduction. Supportive strategies, such as use of a symptom diary, may be helpful in diagnosing and managing the disorders. In women with moderate symptoms, treatment includes both medication and lifestyle modifications. Dietary supplements, such as calcium and evening primrose oil, may offer modest benefit. Selective serotonin reuptake inhibitors such as fluoxetine and sertraline are the most effective pharmacologic agents. Prostaglandin inhibitors and diuretics may provide some relief of symptoms. Only weak evidence supports the effectiveness of gonadotropin-releasing hormone agonists, androgenic agents, estrogen, progesterone, or other psychotropics, and side effects limit their use.

Adult↗
PubMed1994

Premenstrual syndrome.

Premenstrual syndrome is characterized by an array of somatic, cognitive, affective and behavioral disturbances that recur in cyclic fashion during the luteal phase of the menstrual cycle. The goal of management is to control symptoms well enough that the patient can function appropriately at all stages of the menstrual cycle. Both the patient and the physician must acknowledge that premenstrual syndrome is a complex reproductive disorder with a large number of possible manifestations; therefore, they must be willing to consider more than one strategy, and they must allow sufficient time to seek out successful therapeutic options. The patient must play an active role in all stages of management. Although no specific cure for premenstrual syndrome currently exists, most patients experience significant reduction of symptoms and improvement of quality of life when a rational individualized approach is used. Management may involve pharmacologic, nutritional and psychosocial interventions.

Female↗
PubMed1990

Premenstrual syndromes.

Premenstrual Syndrome and Late Luteal Phase Dysphoric Disorder are two commonly cited premenstrual syndromes. Some of the problems in research include prospective vs retrospective rating scales, lack of confirmation of treatment response by double-blind studies, and a large placebo response. Treatment is still largely empiric. Many patients who present with premenstrual complaints may benefit from psychiatric referral.

Female↗
PubMed1989

The treatment of premenstrual syndrome.

Premenstrual syndrome is commonly found among GP female attenders of childbearing age. This article discusses the main types of drug therapies used to treat premenstrual syndrome. Guidelines are also given on the management of these patients incorporating nondrug treatments such as behavioural methods and supportive counselling for associated psychosocial difficulties.

Adult↗
PubMed2006

Psychological aspects of premenstrual syndrome.

Premenstrual syndrome (PMS) is a group of psychological and physical symptoms which regularly occur during the luteal phase of the menstrual cycle and resolve by the end of menstruation. The severe and predominantly psychological form of PMS is called premenstrual dysphoric disorder (PMDD). The exact aetiology of PMS is not known. PMS results from ovulation and appears to be caused by the progesterone produced following ovulation in women who have enhanced sensitivity to this progesterone. The increased sensitivity may be due to neurotransmitter (mainly serotonin) dysfunction. The key diagnostic feature is that the symptoms must be absent in the time between the end of menstruation and ovulation. Prospective symptom rating charts are used for this purpose. Treatment is achieved by suppression of ovulation or reducing progesterone sensitivity with selective serotonin re-uptake inhibitors. In this chapter, the authors describe the aetiology, symptoms, diagnosis and evidence-based management of premenstrual syndrome.

Female↗
PubMed1985

Recognition and treatment of premenstrual syndrome.

Premenstrual syndrome (PMS) is the title applied to a broad range of physical and psychological symptoms that occur cyclically, usually seven to 14 days prior to the onset of a woman's menstruation, and disappear during menstruation. Although the symptoms of premenstrual syndrome were described more than 50 years ago, recognition of PMS by the medical establishment as a discrete condition, which requires attention and treatment, is a fairly recent development. It is estimated that 30 percent of women experience PMS in a debilitating form at some point in their lifetimes from menarche to menopause. The symptomatology of PMS is varied; it includes such psychological symptoms as irritability, depression, oversensitivity, mood swings and anxiety, in addition to such physical symptoms as water retention, breast tenderness, weight gain and migraines. This broad range of symptoms has increased the difficulty of establishing an etiology for the syndrome, and it is now suggested that there may be several processes at work, each responsible for a different aspect of PMS. Care of the PMS patient by nurse practitioners initially requires acknowledgment of the legitimacy of her condition. A detailed physical examination should be accompanied by careful interviewing to elicit the most complete picture of the patient's experience with PMS. Treatment, which can involve dietary changes, hormone or antigonadotropin administration, must be individualized according to a patient's initial symptomatology and subsequent response. At present, research is in progress which will enhance our understanding and ability to deal with PMS.

Adult↗
PubMedDate not supplied

[Modern aspects of the premenstrual syndrome].

Premenstrual Syndrome (PMS) has being a more and more current problem in gynaecology nowadays. The outstanding of symptoms with their repercussion in the psychosocial sphere, no matter whether the problems of psysiological nature are primary oe secondary characteristics of PMS, all inclusive perception of this syndrome. There are individual various aeriological factors, i.e. pathophysiological mechanisms responsible for PMS development, with precisely known varieties of symptom expression, being dominant and frequent, which contribute to the choice of the most suitable therapy. The paper presents a review of various therapeutical possibilities that will make possible the establishment of up-to-date concepts of the premenstrual syndrome treatment, individualized and harmonized according to the current knowledge of dysfunction of relevant system and presence of neuroendocrinological imbalance, responsible for the development of specific PMS symptoms.

Female↗
PubMed1992

Assessment and management of premenstrual syndrome.

Premenstrual syndrome has recently become the subject of more rigorous scientific scrutiny. As a result, techniques exist for accurate diagnosis, and the pathophysiology of the disorder is less mysterious. At present, the disorder is thought to be the caused by the interaction of cyclic changes in estrogen and progesterone with a variety of systems, particularly neurotransmitters. Serotonin appears to play an especially important role in this regard. Increased understanding of premenstrual syndrome has enabled the development of specific treatment modalities that, unlike previous prescriptions, have demonstrated efficacy in rigorous and reproducible studies.

Diet↗
PubMed1984

Abnormal essential fatty acid levels in plasma of women with premenstrual syndrome.

Premenstrual syndrome is now recognized as a condition that probably has an endocrine or biochemical basis. However, it has proved difficult to demonstrate any consistent significant differences from normal in any parameter measured to date. We have measured essential fatty acid levels in phospholipids in plasma taken from 42 women with well-defined premenstrual syndrome. The women were not on any treatment during the cycles when samples were taken in both follicular and luteal phases. The levels of linoleic acid, the main dietary n-6 essential fatty acid, were significantly above normal, indicating no deficit of intake or absorption. In spite of this, concentrations of all metabolites of linoleic acid were significantly reduced, suggesting a defect in conversion of linoleic acid to gamma-linolenic acid. Possibly in compensation, levels of n-3 essential fatty acids were elevated. The same abnormalities were present in both follicular and luteal phases. This abnormality cannot therefore be the direct cause of the symptoms that appear in the luteal phase, but it may sensitize tissues so that they respond abnormally to normal levels of reproductive hormones.

Adult↗
PubMed1998

Treatment strategies for premenstrual syndrome.

Premenstrual syndrome (PMS) refers to a group of menstrually related disorders. Premenstrual symptoms sufficient to impair daily activity and relationships are estimated to occur in up to 40 percent of women of reproductive age, with 5 percent of these women having severe impairment. Although no single causative factor has been identified, PMS is related to ovulatory cycles and resolves at menopause. A specific diagnostic test for PMS does not exist. Treatment is based on the symptoms. Oral contraceptive agents, diuretics and antidepressants have been used successfully to relieve symptoms. Cognitive therapy may help the patient develop appropriate ways to cope with the obstacles, frustrations and discomforts of daily life. Although dietary deficiencies may be difficult to demonstrate, nutritional supplementation may result in significant improvement. Various treatments, including progesterone supplementation, vitamin B6 in high doses, alprazolam and gonadotropin-releasing hormone agonists, are generally not recommended. A comprehensive treatment plan that encourages a healthy lifestyle may relieve symptoms in most women.

Diagnosis, Differential↗
PubMed1998

Luteal-phase estradiol relates to symptom severity in patients with premenstrual syndrome.

Premenstrual syndrome (PMS) is characterized by distressing somatic and behavioral symptoms that develop after ovulation, reach a maximum during the premenstrual days, and disappear within 4 days after the onset of menstruation. Corpus luteum formation is necessary for the presence of symptoms, but the role of luteal hormones is unclear. The aim of this work was to investigate the relationship between sex hormone serum concentrations and premenstrual symptom severity in patients with PMS. Mental and physical symptoms were marked on a validated visual analog scale by 30 PMS patients every evening. Daily blood samples were taken in the luteal phase and in most of the follicular phase. Estradiol, progesterone, FSH, and LH were analyzed. Symptom severity was calculated as the number of negative symptoms expressed per day and as summarized scores of negative ratings. Based on premenstrual hormone concentrations and using the median split method, patients were divided into groups with high and low hormone levels. The pattern of expressed symptoms and summarized scores during the menstrual cycle was similar for the 2 groups. High concentration of luteal-phase estradiol and LH were related to the severity of negative premenstrual symptoms.

Adult↗
PubMed1990

[The premenstrual syndrome].

Premenstrual syndrome is characterized by somatic and psychological symptoms from 5 to 8 days before menstruation and disappearing 34 to 48 hr later. Headache, swelling of breasts, abdominal swelling and weight increase, irritability, fatigue, depression and disturbed personal relations are prominent manifestations. Although hormonal imbalance is invoked in the pathogenesis of the syndrome, there is no agreement regarding specific disturbances. Cultural background greatly influences the clinical expression of this syndrome. A judicious selection of estrogens, progesterone, diuretics, prostaglandin inhibitors, pyridoxine and psychotropic drugs may bring significant relief in most patients.

Adult↗
PubMed1986

Biopsychosocial approach to premenstrual syndrome.

Premenstrual syndrome is a constellation of behavioral, physical and psychologic symptoms that occur every 28 days in some women of childbearing age. A multidimensional, biopsychosocial approach, combining stress reduction, increased exercise and proper diet, has been found effective in treating this syndrome. Medications can be added to relieve symptoms. The cornerstone of this approach is empathic understanding.

Bromocriptine↗
PubMed1984

Premenstrual syndrome.

Premenstrual syndrome is a chronic cyclic disorder with a broad range of morbidity. The syndrome encompasses emotional, behavioral and physical symptoms, usually beginning in the week before menses and ending at the onset of menses or shortly thereafter. To date, the etiology and the most effective treatment are unknown; however, vitamin B6, progesterone and bromocriptine therapies have been advocated.

Affective Symptoms↗