Introduction

A significant number of reproductive age women are affected by various physiologic (breast pain, bloating, headaches, etc.) and emotional changes (irritability, depression, emotional lability or mood swings, etc.) that occur in relation to their menstrual periods.  The majority of these women have PreMenstrual Syndrome (PMS).  A small number of women (3-8%) with PMS experience severe symptoms that usually begin in the week prior to menses and end within several days of menstrual flow.  These women undergo drastic mood swings, personality changes, irritability and depression and have PreMenstrual Dysphoric Disorder (PMDD).

 Diagnosis

Symptoms should be charted over two (2) months in relation to a woman's menstrual period.

PMS:        breast tenderness or pain, bloating, minor mood changes, headache

PMDD:    at least one symptom of: 
               
                depression or lack of well-being, anxiety or tension, emotional lability, irritability

                and include: 

                decreased interest in usual activities, poor concentration, lack of energy, dietary changes
                sleeping difficulties, feeling overwhelmed,  physical symptoms such as breast tenderness or pain, and
                bloating

Treatment

GENERAL SELF-HELP

                1.    Exercise
                2.    Improve Diet
                3.    Dietary Supplements
                        a.    Vitamin B6
                        b.    Vitamin E
                        c.    Calcium
                        d.    Magnesium
                4.    Stress Reduction

PHARMACOLOGICAL TREATMENT

                1.    Pain Relievers
                        a.    Work by relieving physical symptoms
                        b.    Non-steroidal anti-inflammatory agents work the best
                                i.    Ponstel
                                ii.   Ibuprofen
                                iii.  Motrin
                                iv.  Naproxen

                2.    Anti-Depressants and Anxiolytics
                        a.    Work by relieving emotional symptoms
                        b.    Selective Serotonin Reuptake Inhibitors (SSRIs)
                                i.    Fluoxetine (Prozac, Sarafem)
                                ii.   Sertraline (Zoloft)
                                iii.  Paroxetine (Paxil)
                        c.    Tricyclic Antidepressants
                                i.    Clomipramine (Anafranil)
                        d.    Anxiolytics
                                i.    Alprazolam (Xanax)

                3.    Hormonal Treatment
                        a.    Work by altering the menstrual cycle
                        b.    Oral Contraceptives (cyclic or continuous)
                        c.    Estrogens
                                i.    Lose dose estrogen patches (0.025mg Climara) during menses
                        d.    Androgens
                                i.    Danazol
                        e.    Gonadotropin Agonists or Antagonists
                                i.    Lupron
                                ii.   Synarel 
                                iii.  Zoladex

• PMDD - Bulletin Board - www.Dr-Bob.org
• Evaluating and Managing Premenstrual Syndrome (viewing requires free registration with Medscape)
• Will your HMO Pay for PMDD Treatment?
• Search the National Library of Medicine for Articles (enter PMDD and click GO)
• They Say You're Crazy - by Paula J. Caplan
• PMS: A Woman Doctor's Guide by Andrea J. Rapkin, M.D.
• PMS and PMDD cause serious suffering
• NIMH Clinical Studies for PMDD
• FDA Advisory Panel Backs Fluoxetine for PMDD
• Sarafem™
• Calcium and PreMenstrual Balance: Q&A

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