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 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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.
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PMID:Premenstrual syndrome. 1272 53

Premenstrual dysphoric disorder (PMDD) is considered a severe form of premenstrual syndrome. Symptoms of PMDD occur during the last week of the luteal phase of the menstrual cycle and usually abate at the onset of menses. About 3-8% of all menstruating women experience PMDD, which can lead to significant functional impairment. Several randomized, controlled trials have assessed the efficacy of selective serotonin reuptake inhibitors (SSRIs) in the treatment of PMDD. The SSRIs were found to significantly improve symptoms, particularly psychological or behavioral symptoms, during the luteal phase in women with PMDD. Also, SSRIs were found to improve the quality of life in women with PMDD. Headache, fatigue, insomnia, and anxiety were often reported as adverse effects. A decrease in libido or sexual dysfunction also was reported. In recent studies, intermittent SSRI therapy was found to be effective treatment for PMDD and allows a woman to take the drug for only 14 days each month. Intermittent SSRI therapy should be recommended before continuous daily dosing of SSRIs in the treatment of PMDD.
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PMID:Treatment of premenstrual dysphoric disorder with selective serotonin reuptake inhibitors. 1452 45

Premenstrual syndrome consists of different somatic and/or psychological symptoms which occur in the second half of the menstrual cycle following ovulation. The symptoms usually occur around mid-circle and in majority of cases are most intense during the last seven days prior to menstruation. Given the fact that this topic has not been adequately addressed in our country the aims of this study have been defined as to determine the type and frequency of somatic and psychological symptoms related to menstruation. The study was done on the sample of 181 women in the age of 15-52 years, of different educational and marital status. Four groups were formed: married (78), single (103), and adult (138) and adolescent (43). In order to determine the type and frequency of symptoms we used a structural interview modified according to DSM-IV criteria. In accordance with DSM-IV criteria 52% of subjects have premenstrual dysphoric disorder, among which 23.4% adolescents, 76.6% adult women. The most frequent somatic symptoms related to menstruation are: swelling of the breasts, weight gain, myalgias, arm and leg swelling (81.8%), changes in appetite (63.5%), sleep problems (55%), headache (47%). The most frequent psychological problems were depressive mood (68%), fatigability and lack of energy (53.6%), anger and social withdrawal (49.7), anxiety (49%), difficulties of concentrating and difficulties with memory (40.7%). There is no statistically significant difference in frequency of symptoms between the groups except in the presence of pain which is significantly more frequent in adolescents. A defeating fact has been noted in that 64.9% of women inadequately define the duration of their menstrual cycle. It is concluded that premenstrual syndrome or premenstrual dysphoric disorder is a significant problem of women in Bosnia-Herzegovina (present in 52% of women) with a range of unpleasant psychological and somatic symptoms. Due to all this as well as the fact that a considerable number of women inadequately define the duration of their menstrual cycle, it is necessary to devote greater attention to this problem by public health professionals, family doctors, gynecologists and psychiatrists alike.
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PMID:[Psychological disorders in women in Bosnia and Herzegovina associated with menstruation]. 1502 63

Kindling and impaired electroencephalophysiology have been suggested to play a role in the pathophysiology of premenstrual dysphoric disorder (PMDD). Levetiracetam is a novel antiepileptic drug which has shown strong anti-kindling activity in animal models of epilepsy. In this preliminary prospective study we examined the safety and efficacy of levetiracetam for the treatment of PMDD. One hundred twenty-three potential patients were prospectively screened to enroll seven patients into the open-label treatment phase of the study. PMDD was diagnosed per DSM-IV-TR criteria and two consecutive months of prospective ratings of Daily Record of Severity of Problems (DRSP). The Mini International Neuropsychiatric Interview (MINI) was used to exclude any co-morbid conditions. Levetiracetam was started at 250 mg qhs at the end of the first week of the follicular phase. Dosage was gradually increased up to 1,500 mg bid as tolerated or clinically effective. The treatment phase lasted 4 months. Response to treatment was evaluated by Clinical Global Impression (CGI) and DRSP scores. Six out of seven patients experienced a considerable decrease in their DRSP scores with levetiracetam, starting from the first treatment cycle. One patient dropped out of the study due to lack of efficacy after one cycle. Medication was fairly well tolerated. Improvements in food cravings and premenstrual headaches were also noted as unexpected benefits. Anticonvulsant medications, specifically levetiracetam, could be effective in the treatment of PMDD. Future double-blind, placebo controlled, randomized studies are warranted and should include larger number of patients.
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PMID:Levetiracetam for treatment of premenstrual dysphoric disorder: a pilot, open-label study. 1849 13

This paper presents 2 case scenarios that illustrate the complexity of diagnosing and managing migraine associated with hormonal changes. Migraine is commonly associated with comorbidies such as depression, anxiety, obesity, cardiovascular disease, as well as other conditions, thereby making management more challenging for the physician and the patient. The first case is a 35-year-old woman who has migraine almost exclusively during menstruation. She is under a physician's care for long-term management of premenstrual dysphoric disorder (PMDD). Achieving a differential diagnosis of pure menstrual migraine is illustrated, and a detailed treatment plan including use of a migraine miniprophylaxis protocol, management of her PMDD, and prescription of acute treatment medications is reviewed. The second case scenario describes the diagnosis of menstrually associated migraine in a woman who suffers from a frequent disabling migraine along with work-related anxiety and depression. This paper reviews her differential diagnosis, laboratory testing, treatment plan, including management of her comorbid anxiety and depressive symptoms.
Headache
PMID:Menstrual migraine: case studies of women with estrogen-related headaches. 1907 59

The vast majority of menstruating women experience uncomfortable symptoms during the premenstrual phase of their menstrual cycles. Although many women do not require specific treatment of their symptoms, approximately 20% to 50% report moderate to severe premenstrual symptoms and about 5% meet the diagnostic criteria for premenstrual dysphoric disorder, the most severe manifestation of premenstrual symptoms. While the etiology of premenstrual symptoms remains unclear, several theories have implicated sex steroids and neurotransmitters in the development and manifestation of symptoms. Further complicating the delineation of etiology is that premenstrual symptoms can be somatic, psychological, or behavioral, as well as a combination of all three. Developing successful interventions for premenstrual symptoms has thus been challenging, with interventions focused on a particular aspect of premenstrual symptomatology. Treatments for premenstrual symptoms include lifestyle changes, cognitive behavioral therapies, and pharmacologic agents including ovulation suppression regimens, antidepressant medications, and anxiolytics.
Curr Pain Headache Rep 2010 Oct
PMID:Gynecological management of premenstrual symptoms. 2066 50

Objective To observe the changes of Chinese medicine (CM) symptoms, the distri- bution characteristics of CM syndromes, and related neuroendocrine levels in premenstrual dysphoric disorder (PMDD) patients. Methods Totally 3 541 female outpatients (18 -45 years old) were inter- viewed by clinical epidemiological questionnaire. According to PMDD diagnostic criteria in DSM-IV , PMDD patients' CM syndromes were identified. Their scores of main symptoms and CM symptoms of common CM syndromes were compared. Contents of 8 neuroendocrine indicators in serum were detected [5- hydroxytryptamine (5-HT) , adrenocorticotropic hormore (ACTH) , angiotensin-II (Ang-II ) , glucocorti- coid (GC), homocysteine (Hcy), melatonin (MLT), nitrogen monoxide (NO), neuropeptide Y (NPY)]. Results Totally 258 PMDD were detected in 3 541 female outpatients (18 -45 years old). The main syn- drome and common syndromes of PMDD patients were reversed invasion of Gan qi syndrome [40.3% (104/258)] and stagnation of Gan qi syndrome [34. 9% (90/258) ], followed by Gan stagnation Pi deficiency syndrome [7.8%(20/258)], Gan stagnation blood stasis syndrome [7.4% (19/258)], Gan stagnation induced fire hyperactivity syndrome [ 6.2% ( 16258 )], Gan stagnation Shen deficiency syndrome [3.1%(8/258)], and Pi-Shen yang deficiency syndrome [0.4%(1258)]. Compared with reversed invasion of Gan qi syndrome, emotional depression and low spirits were main symptoms of stagnation of Gan qi syndrome. Scores for the two symptoms increased (P <0.05). Compared with stagnation of Gan qi syn- drome, irritability, upset, abdominal distension, anxiety, headache, dizziness, insomnia, head distension, bitter mouth, unclear vision were main symptoms of reversed invasion of Gan qi syndrome. Scores for the 10 symptoms increased (P <0.05). Compared with stagnation of Gan qi syndrome, the Hcy level in serum obviously decreased in reversed invasion of Gan qi syndrome (P <0.05). There was no statistical difference in the rest indices (P >0. 05). Conclusions PMDD is closely related to Gan failing to maintain normal flow of qi. Reversed invasion of Gan qi syndrome and stagnation of Gan qi syndrome have different scientif- ic connotations and biological bases. So regulating Gan should be considered as the first choice.
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PMID:[Changes of Main Syndromes of Gan Failing to Maintain Normal Flow of Qi in Premenstrual Dysphoric Disorder]. 3069 24


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