Healthy Skepticism Library item: 1067

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Langone J.
Reducing Torment of PMS
The New York Times 2003 Apr 22
http://www.nytimes.com/2003/04/22/health/books-on-health-reducing-torment-of-pms.html

Full text:

Premenstrual suffering is not to be dismissed or taken lightly, as it has been in countless PMS jokes and in the more callous male view of it as an excuse for any moment of female ill temper.

An obscure diagnosis until the 1970’s, PMS is real enough, a “monthly turmoil,” Dr. Dell writes in her book about an extreme form of PMS that is not “simply a normal part of being female.”

The disorder she discusses in depth, along with “simple” PMS, is premenstrual dysphoric disorder, or PMDD, which is PMS with a vengeance.

Affecting 3 percent to 9 percent of menstruating women, its symptoms – depression, anger, anxiety, irritability, breast tenderness and bloating – are so severe that they interfere with personal, social or work relationships.

There are days, Dr. Dell writes, when a woman with PMDD “feels like there’s an angry stranger living in her head, days when she feels out of control, days when her husband threatens divorce because he cannot stand the mood swings anymore.”

Laced with real-life stories of women who know what PMDD feels like, Dr. Dell’s book also describes the physiological mechanisms behind the disorder and PMS, and she discusses treatments, newly approved prescription medications, complementary therapies, nutrition and stress-reduction techniques.

An ob-gyn and a psychiatrist at the Duke University Medical Center, Dr. Dell devotes ample space to brain chemistry, especially the role of a neurotransmitter, serotonin. Some experts suggest that lower levels of it figure in PMDD.

She makes a case to use serotonin-enhancing drugs, S.S.R.I.‘s, which are specialized treatments for PMDD. Although the drugs seem to be the best medical treatment available, they are not right for everyone and may interact with other drugs.

It is important for a woman who feels her premenstrual symptoms “are ripping her life apart” to discuss with her physician all the medications, supplements, vitamins and herbal medicines that she is taking. Only fluoxetine (Sarafem) and sertraline (Zoloft) have received final approval from the Food and Drug Administration to treat premenstrual symptoms.

“Taking Back the Month” outlines an approach for treating PMS symptoms that excludes drugs. The plan has reduced symptoms in more than 75 percent of the women who have followed its guidelines, the authors report.

The book relies on diet, relaxation and “emerging therapies” that include acupuncture, light therapy, psychotherapeutic herbs and nutritional supplements.

The authors note that two forms of hormonal treatment have been shown to reduce severe premenstrual symptoms. One provides supplementation with natural forms of progesterone; the other suppresses ovulation with oral contraceptives.

There are no hard and fast rules for deciding when to use medication for PMS, the authors say.

“If your mood symptoms are continuing to send you on an emotional roller coaster,” the book says, “you may want to consider taking either micronized progesterone or one of the S.S.R.I. antidepressants.”

But regardless of the medication, “you may find that you can take a lower dose when you combine medication with the lifestyle changes from your PMS plan.”

“The PMDD Phenomenon: Breakthrough Treatments for Premenstrual Dysphoric Disorder,” by Dr. Diana L. Dell and Carol Svec. Contemporary Books, $14.95.

“Taking Back the Month,” by Dr. Diana Taylor and Stacey Colino. Perigee, $14.95