CWC - PMS Article

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PMS

By Bradley G. Goldberg, M.D.

Probably three of the most powerful letters in the English language today. This topic reaches far beyond the medical facts to include several social implications and obvious stereotypical connotations, which makes this the most difficult topic I have addressed so far. However, I will try to remain objective in my discussion.

"Premenstrual Syndrome" has been a recognized condition since ancient times, with scholars such as Aristotle having written on the subject. And then, as now, it was a subject surrounded by many stereotypes and superstitions.

The fact is that most women experience some degree of physical or even emotional discomfort that is associated with the menstrual cycle. The simplest definition of the premenstrual syndrome (PMS) is the appearance of one or more symptoms just prior to menses occurring to such a degree that lifestyle or work is affected, followed by a period of time that is entirely free of symptoms. Although there are over 100 possible symptoms associated with this condition, some of the more common include: breast tenderness, bloating, headache, acne, appetite changes and cravings, and emotional symptoms. The emotional symptoms can range from minor fatigue and irritability to crying spells and depression. These usually occur in the 7 to 10 days before menses begins.

The vast majority of women are able to tolerate these symptoms and go about their daily business, although none the happier. However, in 3-5% of these women, the symptoms are so severe that they cannot function in their normal day to day routines. These women are classified as having the premenstrual dysphoric disorder.

Doctors and scientists have searched long and hard for the cause of PMS, and unfortunately it has not yet been found. However, the most current theory involves abnormalities of serotonin transmission in the brain. This has led to the treatment of these patients with a relatively new class of medications called "serotonin re-uptake inhibitors" including fluoxetine, and sertraline. These medications are far and away the most promising tool we have yet seen for dealing with this problem.

But before a woman jumps into treatment with drugs, there are other therapies that should be tried first. These include; elimination of caffeine, smoking cessation, regular exercise, proper diet, and adequate sleep. An understanding spouse can also help immensely. If you have tried these things and you are still miserable, then by all means, discuss the situation with your doctor because most likely, help is available.

Bibliography

1. Novak’s Gynecology, Twelfth Edition, Jonathan S. Berek, MD, Williams &Wilkins, Baltimore, 1996.

2. Clinical Gynecologic Endocrinology and Infertility, Fifth Edition, Leon Speroff, MD, Williams & Wilkins, Baltimore, 1994.

3. Treatment of premenstrual dysphoric disorder with sertraline during the luteal phase: a randomized, double-blind, placebo-controlled crossover trial. Young, SA, et al., J Clin Psychiatry 1998 Feb; 59 (2): 76-80.

4. Coping with PMS, Vicki L. Seltzer,M.D., Woman’s Health, August 11, 1997.

5. Treatment of premenstrual syndrome with fluoxetine: A double-blind, placebo-controlled, crossover study. Wood, S.H., Obstet and Gynec 1992 Sept; 80 (3): 339-44.

6. Efficacy of depot leuprolide in premenstrual syndrome: effect of symptom severity and type in a controlled trial. Brown, C.S., Obstet and Gyenec 1994 Nov; 84 (5): 779-86.