Woman's World

PMS Not New, But Treatments Are

By Jean Talbert, M.D.

Most reproductive-age women experience some degree of physical and emotional changes as their menstrual cycle approaches. Occasionally, these symptoms are severe enough to be distressing and to affect a woman’s ability to function. It’s nothing new.

This phenomenon was first described by Hippocrates in 370 BC when he noted “agitated blood” making its way to the uterus to be expelled. Occasional reports of cyclic symptoms have appeared in the medical literature over the years, but the term PMS or premenstrual syndrome was not coined until the twentieth century.

PMDD (premenstrual dysphoric disorder), a severe form of PMS, was first described in 1995. Significant PMS affects up to 30 percent of women, while PMDD affects 3-8 percent. It is found in women of all socioeconomic, ethnic and cultural groups equally. In some cases, there may be a genetic predisposition.

The symptoms are variable, but include mood and physical changes that begin sometime after ovulation and continue until the menstrual cycle begins. The most common symptoms are fatigue, bloating, irritability and anxiety. Additional symptoms include feeling sad, hopeless, tense, angry, tearful, having difficulty concentrating, or experiencing insomnia, breast tenderness, weight gain and headaches. PMS is only diagnosed when there are multiple symptoms severe enough to affect function such as job performance or relationships.

Despite numerous studies, the exact cause of PMS is not well understood. Current evidence suggests that it is the result of the interaction of ovarian hormones and brain neurotransmitters, especially serotonin. Many other conditions, such as depression, anxiety and irritable bowel can often be worse pre-menstrually, but symptoms also occur at other times of the month.

A physical exam and blood work can rule out other conditions. A symptom calendar over several months will confirm the cyclic nature of symptoms and assess treatment regimens.

Treatment options vary. Those with mild symptoms may respond well to reassurance and acknowledgement that PMS is real. Regular exercise and relaxation therapy can be very helpful. Chasteberry fruit (Vitex agnus castus) extracts have shown some benefit. Sometimes calcium supplements and vitamin B6 reduce symptoms.

More severe emotional symptoms are best treated with medication. Antidepressants can be extremely beneficial. In some cases, they can be taken just during the two weeks before a menstrual cycle to decrease the risk of side effects. Hormonal manipulation with oral contraceptives containing estrogen and progesterone also may be helpful. Extended cycle oral contraceptives help reduce symptoms by spacing out the frequency of menstrual cycles to every three months or more. The birth control pill Yaz, which contains the progesterone drosperinone, has been FDA approved for the treatment of PMDD.

GnRH agonists, such as Lupron, can alleviate symptoms by suppressing ovarian function and rendering a woman temporarily menopausal. Unfortunately, long-term use of this class of drug leads to some bone loss so treatment is generally limited. Surgical treatment, such as removal of the ovaries, is reserved only for very extreme cases that do not respond to medical management or for women with other concurrent gynecologic problems.

Most women with PMS and PMDD can find a treatment that provides adequate symptom relief. Although treatment may take time to have an effect, the end result can be a tremendous improvement in quality of life.