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

4 THE PREMENSTRUAL SYNDROMES
Table 1.2 Proposed or researched PMS treatments
Non-pharmacological treatments:
● Counseling
● Relaxation therapy
● Psychotherapy
● Cognitive behavioral therapy (CBT)
● Stress management
● Homeopathy
● Intravaginal electrical stimulation
● Rest
● Isolation
● Yoga
● Aromatherapy
● Exercise
● Music therapy
● Hypnosis
● Dietary manipulation
● Salt restriction
● Self-help groups
● Agnus castus
● Irradiation of ovaries
Non-hormonal pharmacological treatments:
● Tranquilizers
● Antidepressants
● Lithium
● SSRIs initial studies
● Vitamin B6
● Beta-blockers
● Evening primrose oil
● Diuretics, spironolactone
● Magnesium, zinc, and calcium
Hormonal treatments:
● Progesterone (pessaries, injections, vaginal gel)
● Progestogens (norethisterone, dydrogesterone,
medroxyprogesterone acetate, Depo-Provera)
● COC pill: cyclical/continuous
● Testosterone
● Bromocriptine
● Mifepristone, RU-486
● Cyproterone acetate
● Tibolone
● Danazol, gestrinone
● Estradiol (oral, patch, implant)
● GnRH agonist analogs
● Non-steroidal anti-inflammatory drugs
(Continued)
Table 1.2 (Continued)
Surgical treatments:
● Hysterectomy
● Hysterectomy and bilateral oophorectomy
● Endometrial ablation techniques
Therapy
In the era from 1950 to the late 1980s and early 1990s,
treatment research moved from anecdotal reporting of
cases through non-blind trials to well-controlled randomized
double-blind trials. However, meta-analysis
had not yet made any impact in this sphere of research.
The area of these studies matched that of the studies of
etiology to a large extent. The number of therapeutic
studies conducted during that time period was huge, as
the existence of PMS had reached public consciousness –
everything available was being used to treat PMS. With
such a large initial placebo response and the existence
of many patients labeled as PMS who had much milder
problems, the pharmaceutical industry and complementary
and alternative therapy companies were having
a field day.
Again, it is not appropriate to list every study: details
will again be found in the individual chapters of this
book or in O’Brien’s book. 1
Table 1.2 aims to summarize the different treatments
which had been proposed or researched. The list is not
intended to be exhaustive but gives a flavor of the range
and number of therapies proposed during the era.
Quantification and definitions
Most early studies relied on the patient’s perception of
her symptoms or the clinician’s diagnosis from history
and observation alone. Through this time period, a great
deal of work was conducted aiming to define PMS more
precisely and to devise methods to measure symptoms.
The first method dedicated specifically to menstrual
or premenstrual symptoms was the Moos, Menstrual
Distress Questionnaire. 11 This was a rating scale which
used a 47-symptom six-point rating scale. Subsequent
new scales followed this template, which used different
combinations of symptom types; scores which ranged
from 0 to 3, 4, 5, 6, and 7. In the same era, the first use
of a visual analog scale (VAS) was published (1979)
and, much later, improvements led to VAS charts that
adhered to the criteria required for PMDD.
Definitions and diagnostic criteria also evolved over
this time period. Having begun with Frank’s PMT and