November 29, 2002, Newsletter Issue #3: Premenstrual Syndrome (PMS)

Tip of the Week

PREMENSTRUAL SYNDROME (PMS)
Gabe Mirkin, M.D.

Dr. Neil Barnard, of The Physicians Committee for Responsible Nutrition in Washington, D.C., has shown that a low-fat, vegetarian diet helps to treat premenstrual syndrome (10). When a woman becomes irritable or depressed, has breast discomfort, retains fluid and wants to eat all the time only in the two weeks before she starts to menstruate, she probably has premenstrual syndrome or PMS.

A woman`s menstrual cycle is divided into two weeks before she releases an egg and the next two weeks after she releases an egg and before she starts to menstruate. Doctors suspect that the symptoms of PMS are caused by hormone changes that occur after a woman releases an egg, but they don`t know which ones. Doctors can prevent PMS by blocking the brain hormones that stimulate the ovaries with injections of leuprolide and then giving her back estrogen and progesterone (1,8,9). They can prevent associated depression by giving the antidepressants, Prozac, Paxil and Zoloft, or they can treat PMS by prescribing spironolactone, a diuretic that blocks the effects of several hormones that are produced after an egg is released (2). Since many of the symptoms of PMS, such as swollen breasts, fingers and ankles and irritability, are associated with fluid retention, some doctors treat PMS with diuretics or salt restriction. However, neither salt restriction nor diuretics are effective in controlling the symptoms of PMS (3).

Many women who claim that they have PMS really have emotional symptoms all the time (4,6,7). Since the treatment for PMS can be different from that of depression, all women who think that they have premenstrual syndrome should keep diaries to find out if their symptoms occur only after they release an egg 10-14 days after the first day of menstruation. If their symptoms occur before then, they have other problems, not PMS (5).

1) CS Brown, FW Ling, RN Andersen, RG Farmer, KL Arheart. Efficacy of depot leuprolide in premenstrual syndrome: Effect of symptom severity and type in a controlled trial. Obstetrics and Gynecology. 1994(Nov)84(5):779-786.

2) MD Wang, S Hammarback, BA Lindhe, T Backstrom. Treatment of premenstrual syndrome by spironolactone: A double-blind, placebo-controlled study. Acta Obstetricia et Gynecologica Scandinavica 74: 10(NOV 1995):803-808.

3) BR Olson, MR Forman, E Lanza, PA Mcadam, G Beecher, LM Kimzey, WS Campbell, EG Raymond, SL Brentzel, B Guttschesebeling. Relation between sodium balance and menstrual cycle symptoms in normal women. Annals of Internal Medicine 125: 7 (OCT 1 1996):564-567.

4) CJ Chuong, DM Burgos. Medical History in Women with Premenstrual Syndrome. Journal of Psychosomatic Obstetrics and Gynaecology. 1995 (March);16(1):21-27.

5) EW Freeman. Premenstrual syndrome: Current perspectives on treatment and etiology. Current Opinion in Obstetrics & Gynecology 9: 3(JUN 1997):147-153. serotonergic antidepressants and a gonadotropin-releasing hormone agonist. Preliminary data suggested efficacy for spironolactone and a carbohydrate-rich beverage.

6) KA Yonkers. The association between premenstrual dysphoric disorder and other mood disorders. Journal of Clinical Psychiatry 58: Suppl. 15 (1997):19-25.

7) PMS is associated with a high rate of clinical depression. CA Roca, PJ Schmidt, DR Rubinow. A follow-up study of premenstrual syndrome. Journal of Clinical Psychiatry, 1999, Vol 60, Iss 11, pp 763-766.

8)I Sundstrom, S Nyberg, M Bixo, S Hammarback, T Backstrom. Treatment of premenstrual syndrome with gonadotropin-releasing hormone agonist in a low dose regimen. Acta Obstetricia et Gynecologica Scandinavica, 1999, Vol 78, Iss 10, pp 891-899. GnRH-agonist intranasally in a dosage of 100 mu g once daily for two months.

9) AT Leather, JWW Studd, NR Watson, EFN Holland. The treatment of severe premenstrual syndrome with goserelin with and without `add-back` estrogen therapy: a placebo-controlled study. Gynecological Endocrinology, 1999, Vol 13, Iss 1, pp 48-55

ND Barnard, AR Scialli, D Hurlock, P Bertron. Diet and sex-hormone binding globulin, dysmenorrhea, and premenstrual symptoms. Obstetrics and Gynecology, 2000, Vol 95, Iss 2, pp 245-250.

Health Reports from The Dr. Gabe Mirkin Show and DrMirkin.com

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