-
American Family Physician Aug 2016Premenstrual disorders affect up to 12% of women. The subspecialties of psychiatry and gynecology have developed overlapping but distinct diagnoses that qualify as a... (Review)
Review
Premenstrual disorders affect up to 12% of women. The subspecialties of psychiatry and gynecology have developed overlapping but distinct diagnoses that qualify as a premenstrual disorder; these include premenstrual syndrome and premenstrual dysphoric disorder. These conditions encompass psychological and physical symptoms that cause significant impairment during the luteal phase of the menstrual cycle, but resolve shortly after menstruation. Patientdirected prospective recording of symptoms is helpful to establish the cyclical nature of symptoms that differentiate premenstrual syndrome and premenstrual dysphoric disorder from other psychiatric and physical disorders. Physicians should tailor therapy to achieve the greatest functional improvement possible for their patients. Select serotonergic antidepressants are first-line treatments. They can be used continuously or only during the luteal phase. Oral contraceptives and calcium supplements may also be used. There is insufficient evidence to recommend treatment with vitamin D, herbal remedies, or acupuncture, but there are data to suggest benefit from cognitive behavior therapy.
Topics: Calcium; Cognitive Behavioral Therapy; Contraceptives, Oral, Hormonal; Dietary Supplements; Female; Humans; Premenstrual Dysphoric Disorder; Premenstrual Syndrome; Selective Serotonin Reuptake Inhibitors
PubMed: 27479626
DOI: No ID Found -
The Journal of Obstetrics and... Feb 2023Recently, the term premenstrual disorders (PMDs), which includes premenstrual syndrome and premenstrual dysphoric disorder as a continuum, has been proposed. Although... (Review)
Review
Recently, the term premenstrual disorders (PMDs), which includes premenstrual syndrome and premenstrual dysphoric disorder as a continuum, has been proposed. Although the precise etiology of PMDs remains unknown, the involvement of hormonal fluctuations is clear. The brain transmitters, serotonin and γ-amino butyric acid, also seem to be involved. Serotonin reuptake inhibitors and oral contraceptives are the current mainstay of treatment, but these are insufficient. Even the currently used prospective two-period symptom diary is not widely used in actual clinical practice, creating a major problem of discrepancy between research and clinical practice. In this review, I would like to outline the latest information and problems in the etiology, diagnosis, and treatment of PMDs, with an emphasis on promising new therapies.
Topics: Female; Humans; Premenstrual Dysphoric Disorder; Prospective Studies; Premenstrual Syndrome; Contraceptives, Oral; Selective Serotonin Reuptake Inhibitors
PubMed: 36317488
DOI: 10.1111/jog.15484 -
American Family Physician Apr 2003Premenstrual syndrome, a common cyclic disorder of young and middle-aged women, is characterized by emotional and physical symptoms that consistently occur during the... (Review)
Review
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.
Topics: Adult; Diagnosis, Differential; Female; Humans; Premenstrual Syndrome
PubMed: 12725453
DOI: No ID Found -
Lancet (London, England) Apr 2008Most women of reproductive age have some physical discomfort or dysphoria in the weeks before menstruation. Symptoms are often mild, but can be severe enough to...
Most women of reproductive age have some physical discomfort or dysphoria in the weeks before menstruation. Symptoms are often mild, but can be severe enough to substantially affect daily activities. About 5-8% of women thus suffer from severe premenstrual syndrome (PMS); most of these women also meet criteria for premenstrual dysphoric disorder (PMDD). Mood and behavioural symptoms, including irritability, tension, depressed mood, tearfulness, and mood swings, are the most distressing, but somatic complaints, such as breast tenderness and bloating, can also be problematic. We outline theories for the underlying causes of severe PMS, and describe two main methods of treating it: one targeting the hypothalamus-pituitary-ovary axis, and the other targeting brain serotonergic synapses. Fluctuations in gonadal hormone levels trigger the symptoms, and thus interventions that abolish ovarian cyclicity, including long-acting analogues of gonadotropin-releasing hormone (GnRH) or oestradiol (administered as patches or implants), effectively reduce the symptoms, as can some oral contraceptives. The effectiveness of serotonin reuptake inhibitors, taken throughout the cycle or during luteal phases only, is also well established.
Topics: Adolescent; Adult; Contraceptives, Oral, Hormonal; Female; Humans; Mood Disorders; Panic Disorder; Premenstrual Syndrome; Selective Serotonin Reuptake Inhibitors
PubMed: 18395582
DOI: 10.1016/S0140-6736(08)60527-9 -
Menopause International Jun 2012
Topics: Female; Hormone Replacement Therapy; Humans; Perimenopause; Premenstrual Syndrome; Terminology as Topic
PubMed: 22611219
DOI: 10.1258/mi.2012.012012 -
American Journal of Obstetrics and... Jan 1981The premenstrual syndrome (PMS) is a major clinical entity afflicting a large segment of the female population. Available information are descriptive in nature and the... (Review)
Review
The premenstrual syndrome (PMS) is a major clinical entity afflicting a large segment of the female population. Available information are descriptive in nature and the etiology of this syndrome remains unclear. In this review, both biochemical and psychosocial elements of the syndrome have been explored in an effort to redefine the pathophysiology of this seemingly multifactorial psychoneuroendocrine dysfunction. We propose that luteal phase sensitivity to and subsequent withdrawal from the central effects of the neuropeptides beta-endorphin and alpha-melanocyte-stimulating hormone result in a cascade of neuroendocrine changes within the brain-hypothalamus-pituitary complex. Modulation of neurotransmitter function by these peptides may produce alterations in mood and behavior as well as enhance pituitary release of prolactin and vasopressin. Variable gonadal steroid modulation of these responses from subject to subject likely accounts for the heterogeneous clinical manifestations of the PMS.
Topics: Adult; Avitaminosis; Contraceptives, Oral; Endorphins; Estrogens; Female; Hormones; Humans; Hypersensitivity; Hypoglycemia; Melanocyte-Stimulating Hormones; Premenstrual Syndrome; Progesterone; Syndrome; Water-Electrolyte Balance
PubMed: 7006400
DOI: 10.1016/0002-9378(81)90417-8 -
Frontiers in Endocrinology 2022Premenstrual syndrome (PMS), a recurrent and moderate disorder that occurs during the luteal phase of the menstrual cycle and quickly resolves after menstruation, is... (Review)
Review
Premenstrual syndrome (PMS), a recurrent and moderate disorder that occurs during the luteal phase of the menstrual cycle and quickly resolves after menstruation, is characterized by somatic and emotional discomfort that can be severe enough to impair daily activities. Current therapeutic drugs for PMS such as selective serotonin reuptake inhibitors are not very satisfying. As a critical pineal hormone, melatonin has increasingly been suggested to modulate PMS symptoms. In this review, we update the latest progress on PMS-induced sleep disturbance, mood changes, and cognitive impairment and provide possible pathways by which melatonin attenuates these symptoms. Moreover, we focus on the role of melatonin in PMS molecular mechanisms. Herein, we show that melatonin can regulate ovarian estrogen and progesterone, of which cyclic fluctuations contribute to PMS pathogenesis. Melatonin also modulates gamma-aminobutyric acid and the brain-derived neurotrophic factor system in PMS. Interpreting the role of melatonin in PMS is not only informative to clarify PMS etiology but also instructive to melatonin and its receptor agonist application to promote female health. As a safe interaction, melatonin treatment can be effective in alleviating symptoms of PMS. However, symptoms such as sleep disturbance, depressive mood, cognitive impairment are not specific and can be easily misdiagnosed. Connections between melatonin receptor, ovarian steroid dysfunction, and PMS are not consistent among past studies. Before final conclusions are drawn, more well-organized and rigorous studies are recommended.
Topics: Female; Humans; Luteal Phase; Melatonin; Menstrual Cycle; Premenstrual Syndrome; Progesterone; Estrogens
PubMed: 36699021
DOI: 10.3389/fendo.2022.1084249 -
Archives of Women's Mental Health Dec 2022
Topics: Female; Humans; Premenstrual Syndrome; Luteal Phase
PubMed: 36302900
DOI: 10.1007/s00737-022-01270-4 -
Der Nervenarzt Mar 2024Premenstrual syndrome and premenstrual dysphoric disorder become episodically manifest during the second half of the female menstrual cycle and are characterized by... (Review)
Review
Premenstrual syndrome and premenstrual dysphoric disorder become episodically manifest during the second half of the female menstrual cycle and are characterized by psychological and physical symptoms causing relevant functional and social impairments. Mood swings, depression and dysphoria are associated depressive symptoms. Therefore, affective disorders should be considered as a differential diagnosis. Of women in reproductive age 3-8% suffer from premenstrual syndrome and 2% of women are affected by premenstrual dysphoric disorder. Genetic and sociobiographical risk factors are discussed. Furthermore, genetic polymorphisms of specific hormone receptors are considered to be genetic risk factors. From a pathophysiological perspective premenstrual syndrome and premenstrual dysphoric disorder are caused by a complex interaction between cyclic changes of ovarian steroids and central neurotransmitters. An imbalance of estrogen and progesterone in the luteal phase is believed to cause the symptoms. Therefore, the first treatment approach consists of regulation of the menstrual cycle or luteal support with progesterone or synthetic progestins even if their effectiveness has not yet been proven in randomized controlled studies and meta-analyses. The administration of combined oral contraceptives is also an option. Especially treatment with selective serotonin reuptake inhibitors (SSRI) represent an evidence-based approach. In severe cases the administration of gonadotropin releasing hormone (GnRH) agonists with add back treatment can also be considered. In the field of affective disorders premenstrual syndromes represent clinically relevant differential diagnoses and comorbidities, which confront the treating physician with particular clinical challenges. Therefore, this literature review gives the readership a clinical orientation for dealing with these disorders.
Topics: Female; Humans; Child, Preschool; Premenstrual Dysphoric Disorder; Progesterone; Premenstrual Syndrome; Mood Disorders; Anxiety
PubMed: 38393358
DOI: 10.1007/s00115-024-01625-5 -
International Journal of Psychiatry in... 1991The Premenstrual Syndrome (PMS) was described as a unique entity meriting therapeutic attention in 1931. Although researchers in the area have failed to develop a widely... (Review)
Review
The Premenstrual Syndrome (PMS) was described as a unique entity meriting therapeutic attention in 1931. Although researchers in the area have failed to develop a widely accepted definition of PMS, substantial progress has been made in describing the variety of psychobiological profiles encompassed by this syndrome, particularly with respect to its typical symptoms, cyclical nature, symptoms recurrence and severity. Therapies ranging from diet and exercise to vitamin, hormone and drug treatment have been proposed. While none is more efficacious than placebo, several have been popularized. Our failure to develop adequate treatment may reflect our lack of understanding of either the psychosocial or biological factors involved in PMS. This, in turn, may reflect inadequate theoretical development in this research area. We provide a critical assessment of research on PMS, suggest a framework for theoretical development and advocate research strategies that might provide insights into the etiology of the premenstrual syndrome.
Topics: Adult; Female; Humans; Premenstrual Syndrome
PubMed: 1774124
DOI: 10.2190/1CET-D610-UHEB-YNG6