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

40 THE PREMENSTRUAL SYNDROMES
examines the effect of PMS and PMDD on interpersonal
functioning, work functioning, and healthcare
utilization.
Studies with PMS determined by
a single-item question
Outpatient female veterans who endorsed PMS by a
single (yes–no) item (N � 445) reported significantly
lower SF-36 scores across all domains except energy/
vitality compared with 574 women without any menstrual
problems. 42 Compared with 26 women who
claimed that they did not have PMS, 26 women who
endorsed PMS had significantly more marital and
family relationship dissatisfaction. 43 Another study
reported a lack of absenteeism and objective work
impairment in a group of women who reported having
PMS. 44
A random survey study of 220 women who stated
that they had PMS reported that these women felt that
the majority of physicians were not adequately informed
to diagnose and treat them. 45 Even though satisfaction
with antidepressants was high, only 15% of women
had tried them. Many women had used vitamin/mineral
supplements, exercise, natural progesterone, and diet
changes in the past year. Phone assessment of a random
national sample of 1052 women resulted in 41% of the
women endorsing PMS. 46 Of these women, 42% took
over-the-counter regimens for PMS, primarily analgesics,
and only 3% took prescription medications. This
study identified exercise and alternative and homeopathic
treatments as also being tried.
Studies with PMS diagnosed by
retrospective survey
Compared with women without PMS, women with
PMS as defined by the PAF demonstrated marital dysfunction
in the luteal phase. 47 In a population cohort
from Sweden, 10% of 1083 women were unable to
work at least once during the preceding 6 months due
to PMS, and the inability to work was associated with
the severity of emotional and physical symptoms. 30,48 In
a survey of 658 women in Britain who stated that they
had PMS after completing a questionnaire derived from
the MDQ, 55% stated that PMS had a major effect on
their relationship with their spouse, 43% stated an
effect with their children, and 33% stated an effect on
their work. 49 Almost half of this sample had visited
their general practitioner specifically for PMS over the
past year, and over the previous month 46% had taken
analgesics, 9% had taken vitamins, and 11% had taken
psychotropic medication.
Between 11% and 32% of 310 women were considered
to have severe PMS as evaluated by the PAF on a
cross-sectional retrospective survey of 310 women in
general medicine practices in Australia. 50 Interpersonal
relationship problems were more frequent than a negative
impact on work attendance. Approximately half of
the women had sought help for premenstrual symptoms
and 85% had tried a prescription or over-the-counter
medication. At least one-third of the women had tried
analgesics, rest, exercise, drinking more fluids, vitamins,
and oral contraceptives.
Studies with PMDD diagnosed by
retrospective survey
In the study by Wittchen and colleagues described
above, women with PMDD and subthreshold PMDD
both reported significantly more acute impairment in
their professional and everyday activities over the
preious 4 weeks compared to women without PMDD. 19
Both PMDD groups also utilized medical and mental
health practitioners significantly more than women
without PMDD. However, the groups did not differ in
use of psychotropic medication or over-the-counter
preparations for premenstrual symptoms. The results
of this study underscored that significant premenstrual
symptoms, functional impairment, and healthcare utilization
occurred in almost 25% of women aged 14–24
years old (combining the provisional PMDD and subthreshold
PMDD groups) in a sizeable population
cohort.
In the study by Steiner and colleagues described above,
involving 508 women visiting a primary care clinic, the
administration of the PSST confirmed decreased interest
in work, home, and social activities in 57.7%, 69.2%,
and 65.4%, respectively, of women meeting criteria for
PMDD. 22 Decreased interest in work, home, and social
activities was endorsed by 54.1%, 51.0%, and 48.5%,
respectively, of women meeting criteria for moderate–
severe PMS. These results lend further documentation
of the substantial functional impairment in the 21% of
women with severe PMS who do not meet the full
severity criteria of PMDD. 22
In the cross-sectional study of 1045 women conducted
in the USA, UK, and France described above, functional
impairment was highest at home; however, 8–16% of
the sample reported missing work in the previous year
due to premenstrual symptoms. 23 Approximately 25%
of the women across the three nations had sought
medical help for PMS, non-prescription medication use
occurred in 20–47% of the sample, and prescription
medication use occurred in 3–11% of the sample.
Again, SSRIs had not yet been approved by regulatory
authorities for PMDD at the time of this study.