Non-medical therapies

Unsubstantiated claims of calcium, magnesium, vitamin E and vitamin B6 supplementation alleviating some of the symptoms of PMS have been made. Similarly, some claims suggest that dietary changes, evening primrose oil, St Johns Wort, exercise, yoga, acupuncture, psychotherapy and exercise may help resolve some of the symptoms of PMS. This is not surprising as consuming certain foods, exercise, yoga and acupuncture are associated with increased production and release of serotonin, a neurotransmitter whose inadequate production during the luteal phase is implicated in the pathophysiology of PMS. See RAGING MENSTRUAL HORMONE: CAUSES AND DIAGNOSIS OF PREMENSTRUAL SYNDROME for further explanation from.

Medical therapies

Broadly speaking, treatment of PMS is achieved by the following methods;

1). Suppression of ovulation/menstrual cycle either by drugs or by surgery in other to suppress the rise in progesterone level that occurs in the luteal phase of the menstrual cycle in women unusually sensitive to the normal rise in progesterone that occur in the luteal phase of the menstrual cycle.

2). Elevating the serotonin levels in the blood with medications hence counteracting the abnormal response to progesterone by the use of selective serotonin reuptake inhibitors (SSRIs).

Ovulation/Menstrual cycle suppression:

This is the most common approach to management of PMS. It can be achieved by the use of drugs or in certain instances via the use of surgery.

Drugs that may be used include:

Danazol: This is a synthetic steroid hormonal drug that is particularly effective for most symptoms of PMS. Fear of its masculinizing side effects has limited its use generally, but such side effects are very minimal if it is used only during the luteal phase of the menstrual cycle, however its effectiveness becomes limited only for the breast symptoms.

GnRH agonist: These are drugs used to cause total suppression of the ovarian activities a term known as medical oophorectomy. Examples include buserelin and goserelin. They are highly effective in achieving complete resolution of symptoms, but their use is limited to a rather short period of time due to their associated menopausal side effects. Add back therapy using systemic estrogen preparations are given to such patients along side with the GnRH agonist in other to relieve the menopausal side effects and prolong the period of use of the GnRH agonist.

Oral contraceptive Pills (OCPs): OCPs are pills used daily for the purpose of contraception. They exert their action by inhibiting or preventing ovulation and contain various estrogen and progesterone preparations. Granted that PMS is caused by unusual sensitivity to progesterone in some women, depending on the progesterone preparation, OCP may not be effective in the management of PMS. However, yasmin, an OCP with anti-mineralocorticoid and an anti-androgenic progestogen appears to be the most effective OCP for PMS, the most effective regimen being by either bicycling or tricycling pill packets (i.e. taking two or three packets in a row without a scheduled break).

Oestradiol: This is the most potent form of the female hormone estrogen. When given as either patches or implants, it effectively suppresses the ovarian cycle without inducing the negative menopausal side effects of surgical or medical oophorectomy. This however poses a problem in women with an intact uterus. There is an associated risk of endometrial hyperplasia, a pre-cancerous stage of endometrial cancer which can only be prevented by re-introducing progesterone into the medications. Unfortunately reintroducing systemic or oral progesterone preparations reintroduces PMS. However, mirena an intra uterine device (IUD) containing progesterone can be used with the above to prevent endometrial hyperplasia because it acts locally on the uterine endometrium and avoids the systemic side effect of progesterone including PMS in women with intact uterus, otherwise, estradiol is only ideal for women without a uterus following hysterectomy.

Surgical treatment: In women, who have completed their family size and have no need for more children, the surgical removal of the ovaries and the uterus which is known medically as Total abdominal hysterectomy and bilateral oophorectomy effectively removes the ovarian cycle totally and thus ideal for women with PMS associated with any other medical condition involving the uterus. A follow up medication with estradiol subsequently prevents menopausal side effect that is bound to follow the surgical removal of the ovaries.

Elevating blood serotonin level

The use of selective serotonin reuptake inhibitors (SSRIs) originally devised to tackle depression has been found to eliminate or remove most of the physical and non-psychological symptoms of PMS. An example of such drug is fluoxetine. Although it can be prescribed for use throughout the menstrual cycle, it is preferably used in the luteal phase in other to reduce the loss of libido often associated with its use.

Hence, it is obvious that PMS represent a few but significant percentage of women experiencing distressing premenstrual symptoms who requires medical help and such women should endeavor to seek proper help of a certified specialist for proper treatment.

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