Premenstrual Syndromes : PMS and PMDD - Rutuja :: The site ...

Preface
Somatic, affective, and behavioral symptoms can occur
during the premenstrual phase of the menstrual cycle of
nearly all ovulatory women. The nature and severity of
these symptoms constitute a spectrum from minimal to
disabling; however, the distinction between normal and
pathological symptoms is one of the principal dilemmas
in this area of research. The severity of interference
with daily activities depends on various as yet poorly
defined factors, but etiology probably includes genetic,
neurochemical, and environmental factors. Are we
really, in this era of high technology, limited to the use
of simple paper-based rating scales to record the impact
of symptoms on normal functioning, on school and
work performance, and on ability to socialize? Yes, at
present, this remains the most reliable way to distinguish
between what is physiological and what constitutes
a premenstrual disorder, premenstrual syndrome
(PMS) or premenstrual dysphoric disorder (PMDD).
Awareness of such premenstrual problems amongst
women, their partners, general practitioners, gynecologists,
psychiatrists, other health professionals and, particularly,
the media has increased dramatically over the
past 30 years.
Even so, there are sceptics who say that premenstrual
symptoms or disorders have been exaggerated and
medicalized by the profession and the pharmaceutical
industry, in order to ‘peddle’ their hormones (progestagens
and estrogen) or antidepressants (notably selective
serotonin reuptake inhibitors, SSRIs). Complementary
and alternative practitioners have also offered a range
of treatments: some ineffective; others, poorly studied,
but possibly effective. Premenstrual symptoms, similar
to many affective and behavioral symptoms, exhibit a
very high response to placebo, and significant symptoms
can occur in at least 20% of women. The lack of
consensus on the nature of this condition creates a void
of knowledge, in which some women may unfortunately
become targets for exploitation. However, it is of
paramount importance that scientific research continues
and that the medical community recognizes and
cares for these disorders. It would be a great disservice
to women and society if those in the medical community
(who have insufficient knowledge and understanding)
approach these problems with disdain.
Premenstrual syndrome is amongst a unique, small
number of disorders where the patient frequently
arrives at the specialist with their own diagnosis and it
is the practitioner’s role to exclude or confirm the diagnosis.
The lack of an objective means of confirming the
diagnosis and monitoring treatment is a great problem.
This may be one of the reasons why the credibility of
the diagnosis of PMS has been questioned. Although
this is probably true for other psychological disorders,
it is probably more so for PMS.
In the USA and in Australasia, PMS is recognized
as a serious entity, but in the UK and continental
Europe less so. The National Institute of Mental Health
(NIMH) in Washington, DC, the American Psychiatric
Association, and the American College of Obstetricians
and Gynecologists (ACOG) respect the validity of these
disorders in that research program grants, evidencebased
clinician guidance, and patient information are
well-established and widely disseminated. By contrast,
in the UK, all PMS/PMDD research has been led by the
pharmaceutical industry and only now, for the first
time, is the Royal College of Obstetricians and Gynaecologists
developing evidence-based guidance for treatment.
The situation in the rest of Europe probably falls
somewhere between these two extremes. A patient/consumer
group in the UK, The National Association of
Premenstrual Syndrome, has been the focus of activity
in the field and has a relatively scientific view of most