Premenstrual syndrome (PMS), that
little-understood, little-studied ailment so common among women, seems to be
garnering a greater consensus among doctors on how to diagnose and treat it.
According to the American College of Obstetricians and Gynecologists (ACOG),
PMS treatment has been hampered by imprecise diagnostic standards, poorly
designed clinical trials, and the promotion of therapies that lack scientific
support. In recent years, however, a growing number of solid studies have
pointed the way to better PMS diagnosis and treatment. Based on this research,
ACOG has issued new management guidelines for the condition.
In a Practice Bulletin released Friday, ACOG notes that while an estimated
85% of menstruating women experience one or more premenstrual symptoms, far
fewer actually have PMS. About 5% to 10% of women have debilitating symptoms.
Premenstrual symptoms include bloating, headache, fatigue, depression, and
irritability.
For unknown reasons, many medical conditions worsen during the premenstrual
phase. Before doctors label a condition PMS, according to ACOG, they should rule
out disorders such as migraine, irritable bowel syndrome, depression, asthma,
and allergies. Generally, it is PMS if a woman has at least one mood symptom and
one physical symptom during the 5 days before a period, for three consecutive
months.
As for treatment, many tactics have been recommended, but few have been
rigorously studied. The current consensus, ACOG states, holds that women should
first be treated with "supportive therapy," such as dietary changes, exercise,
and nutritional supplements. If this fails, women may do better with drug
treatment or ovulation suppression -- with birth control pills, for instance.
The few treatment approaches that have at least some scientific evidence of
their benefits include regular aerobic exercise, carbohydrate-rich diets, and
calcium supplements. Studies of vitamins B6, E, and magnesium have had
inconsistent results. A drug class known as selective serotonin reuptake
inhibitors (SSRIs) is the "initial drug of choice for severe PMS," according to
the report.
These drugs prolong the action of serotonin, a chemical produced by nerve
cells that is believed to be involved in premenstrual symptoms. One SSRI, called
fluoxetine, has been studied in about 1,000 women.
Birth control pills, according to ACOG, have not been shown to be especially
effective for PMS, and should only be prescribed if a woman's symptoms are
"primarily physical." Another hormone suppressing drug class,
gonadotropin-releasing hormone agonists, may be effective, but side effects --
including long-term bone loss -- limit the drugs' usefulness.
