Premenstrual syndrome. Identification and management

Premenstrual dysphoric disorder: prevalence, diagnostic considerations, and controversies

Premenstrual dysphoric disorder (PMDD) has been included as a formal diagnosis of a mood disorder in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition in 1994. The ensuing, critical attention has resulted in increased research productivity and clinical recognition of this neglected women's health problem. A decade later, this paper will review the current literature on PMDD focusing on prevalence, biopsychosocial etiological correlates, history of the development of a formal DSM diagnosis, and the controversies surrounding the current classification of PMDD. The authors conclude that PMDD presents a distinct diagnostic entity and that recognition through formal diagnostic criteria serves the important minority of women who suffer from this cyclical mood disorder distinct from premenstrual symptoms and major depression.

Expert Guidelines for the Treatment of Severe PMS, PMDD, and Comorbidities: The Role of SSRIs

The hallmark feature of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) is the predictable, cyclic nature of symptoms or distinct on/offness that begins in the late luteal phase of the menstrual cycle and remits shortly after the onset of menstruation. PMDD is distinguished from PMS by the severity of symptoms, predominance of mood symptoms, and role dysfunction, particularly in personal relationships and marital/family domains. Several treatment modalities are beneficial in PMDD and severe PMS, but the selective serotonin reuptake inhibitors (SSRIs) have emerged as first-line therapy. The SSRIs can be administered continuously throughout the entire month, intermittently from ovulation to the onset of menstruation, or semi-intermittently with dosage increases during the late luteal phase. These guidelines present practical treatment algorithms for the use of SSRIs in women with pure PMDD or severe PMS, PMDD and underlying subsyndromal clinical features of mood or anxiety, or premenstrual exacerbation of a mood/anxiety disorder.

Pharmacological activities of Vitex agnus-castus extracts in vitro

The pharmacological effects of ethanolic Vitex agnus-castus fruit-extracts (especially Ze 440) and various extract fractions of different polarities were evaluated both by radioligand binding studies and by superfusion experiments. A relative potent binding inhibition was observed for dopamine D2 and opioid (micro and kappa subtype) receptors with IC50 values of the native extract between 20 and 70 mg/mL. Binding, neither to the histamine H1, benzodiazepine and OFQ receptor, nor to the binding-site of the serotonin (5-HT) transporter, was significantly inhibited. The lipophilic fractions contained the diterpenes rotun-difuran and 6beta,7beta-diacetoxy-13-hydroxy-labda-8,14-dien . They exhibited inhibitory actions on dopamine D2 receptor binding. While binding inhibition to mu and kappa opioid receptors was most pronounced in lipophilic fractions, binding to delta opioid receptors was inhibited mainly by a aqueous fraction. Standardised Ze 440 extracts of different batches were of constant pharmacological quality according to their potential to inhibit the binding to D2 receptors. In superfusion experiments, the aqueous fraction of a methanolic extract inhibited the release of acetylcholine in a concentration-dependent manner. In addition, the potent D2 receptor antagonist spiperone antagonised the effect of the extract suggesting a dopaminergic action mediated by D2 receptor activation. Our results indicate a dopaminergic effect of Vitex agnus-castus extracts and suggest additional pharmacological actions via opioid receptors.

Prevalence of sexual abuse history in a sample of women seeking treatment for premenstrual syndrome

This study evaluated the prevalence and correlates of sexual abuse history among women seeking treatment for severe premenstrual syndrome (PMS). Of 77 women participating in a randomized clinical trial of non-pharmacological treatments for severe PMS, 42 were interviewed regarding their sexual abuse history. The interviewed women were a mean of 38 years old, and most were of European ancestry, heterosexual, married, employed and well-educated. At least one attempted or completed sexual abuse event was reported by 95% of the women, with 81% reporting completed penetration against their will and 85% of these sustaining physical threat or harm. Compared to prior studies of sexually abused women in general populations, these women were abused earlier in life, more frequently and by similar types of offenders. Most of the abused women (65%) were estimated to have post-traumatic stress disorder (PTSD). Most abused women (83%) had never disclosed the abuse to a health practitioner. The findings suggest that a history of sexual abuse, particularly in childhood or adolescence, may be extremely common among women seeking treatment for severe PMS, and that substantial undiagnosed PTSD may also be present in this population. Implications for patient screening and treatment are discussed.

Effectiveness of professional--peer group treatment: symptom management for women with PMS

The purpose of this intervention study was to determine short- and long-term effectiveness of a symptom management intervention aimed at relieving the distress associated with premenstrual syndrome (PMS). The PMS Symptom Management Program (PMS-SMP), a package of nonpharmacological strategies involving self-monitoring, personal choice, self-regulation, and self/environmental modification, was administered within a group combining peer support and professional guidance to 91 women classified with severe PMS (early treatment groups n = 40; waiting treatment groups n = 51). Repeated behavioral measures (symptom severity and personal resources/demands) were obtained on five occasions: two menstrual cycles prior to treatment and at 3, 6, 12, and 18 months after treatment. A package of symptom management strategies was effective in reducing PMS severity by 75%, premenstrual depression, and general distress by 30-54%, as well as increasing well-being and self-esteem in women experiencing severe PMS. These results compare favorably with antidepressant drug treatment studies that report a 40-52% reduction in PMS severity. The most marked improvement was found in the first 3 months after treatment; however, improvement was maintained or enhanced in the long-term follow-up. Although focused on perimenstrual symptom relief, these strategies are generally health promoting and can be applied to other women's health conditions.