Controversies in Premenstrual Syndrome: Etiology and Treatment

  • P. M. S. O’ Brien

Abstract

It may be premature to discuss the ethical implications of the premenstrual syndrome (PMS) when the scientific foundations of the disorder are so poorly established. There are virtually no conclusive data available concerning its diagnosis or measurement; or specifying the precise endocrine and biochemical changes involved; nor are there any reliable studies enabling us to offer adequate treatment to patients. The present chapter attempts to identify some of the major deficiencies in our understanding of PMS and to assess the efficacies of the treat ments available. Much of the discussion will center around the failure of the majority of research studies to arrive at strict definitions and the inadequate means of characterizing and quantifying PMS when attempting to diagnose individuals and when trying to measure the day-to-day changes in symptoms. Two other important problems relate to etiology: the as yet unproven theories relating to progesterone deficiency, and the frequently reiterated phenomenon of water retention, which has, to date, not been shown to be a consistent component of PMS. Probably one of the most common and fundamental shortcomings in the study of PMS is the failure to include placebo controls in studies of therapy. This is surprising in a syndrome where the placebo effect of any therapy usually has been 40-50 percent, and occasionally greater (Sampson, 1979).

Keywords

Placebo Estrogen Osteoporosis Migraine Testosterone 

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References

  1. Andersch, B., L. Abrahamsson, C. Wendestam, R. Ohman, and L. Hahn, 1979. Hormone profile in premenstrual tension: Effects of bromo criptine and diuretics.Clinical Endocrinology 11: 657–664.PubMedCrossRefGoogle Scholar
  2. Backstrom, T. and H. Carstensen, 1974. Estrogen and progesterone in plasma in relation to premenstrual tension.Journal of Steroid Biochemistry 5: 257–260.PubMedCrossRefGoogle Scholar
  3. Backstrom, T., D. Sanders, R. Leask, D. Davidson, P. Warner, and J. Bancroft, 1983. Mood, sexuality, hormones, and the menstrual cycle: Hormone levels and their relationship to the premenstrual syndrome.Psychosomatic Medicine 45: 503–507.PubMedGoogle Scholar
  4. Backstrom, T., L. Wide, R. Sodergard, and H. Carstensen, 1976. FSH, LH, TeBG capacity, estrogen and progesterone in women with premenstrual tension during the luteal phase.Journal of Steroid Biochemistry 7: 473–476.PubMedCrossRefGoogle Scholar
  5. Benedek-Jaszmann, L. J., R. N. Lequin, and V. Sternthal, 1975. Treatment of the premenstrual syndrome with Bromocriptine.Acta Endocrinologica (Supplement 193): 29.Google Scholar
  6. Bickers, W. and M. Wood, 1951. Premenstrual tension: Rational treatment.Texas Reports on Biology and Medicine 9: 406.PubMedGoogle Scholar
  7. Brush, M. G., 1983. The significance of pyridoxine and gamma-linolenic acid in premenstrual syndrome. In: R. W. Taylor (Ed.), Premenstrual Syndrome. Proceedings of the Workshop at Royal College of Obstetricians and Gynaecologists. Medical News Tribune, Ltd., London, pp. 57–62.Google Scholar
  8. Butt, W. R., J. F. Watts, and G. Holder, 1983. The biochemical background to the premenstrual syndrome. In: R. W. Taylor (Ed.),Premenstrual Syndrome.Proceedings of the Workshop at Royal College of Obstetricians and Gynaecologists. Medical News Tribune, Ltd., London, pp. 16–24.Google Scholar
  9. Clare, A. W., 1983. Psychiatric and social aspects of premenstrual complaints.Psychological Medicine (Monograph Supplement) 4: 1–58.CrossRefGoogle Scholar
  10. Cullberg, J., 1972. Mood changes and menstrual symptoms with different gestagen/oestrogen combinations.Acta Psychiatrica Scandinavica (Supplement): 236.Google Scholar
  11. Dalton, K., 1964.The Premenstrual Syndrome.William Heinemann Medical Books, Ltd., London.Google Scholar
  12. Dalton, K., 1977.The Premenstrual Syndrome and Progesterone Therapy. William Heinemann Medical Books, Ltd., London.Google Scholar
  13. Dalton, K., 1981. Sex hormone-binding globulin concentrations in women with severe premenstrual syndrome.Postgraduate Medical Journal 57: 560–561.PubMedCrossRefGoogle Scholar
  14. Dalton, K., 1984.The Premenstrual Syndrome and Progesterone Therapy(second edition). William Heinemann Books, Ltd., London.Google Scholar
  15. Dennerstein, L., C. Spencer-Gardner, and G. D. Burrows, 1984. Mood and the menstrual cycle.Journal of Psychiatric Research 18: 1-12.Google Scholar
  16. Day, J. B., 1979. Clinical trials in the premenstrual syndrome.Current Medical Research Opinion 6 (Supplement 5): 40-45. Dennerstein, L., C. Spencer-Gardner, and G. D. Burrows, 1984. Mood and the menstrual cycle.Journal of Psychiatric Research 18: 1–12.PubMedCrossRefGoogle Scholar
  17. Faratian, B., A. Gaspar, P.M.S. O’Brien, I. R. Johnson, G. A. Filshie, and P. Prescott, 1984. Weight, abdominal size and perceived body image in premenstrual syndrome.American Journal of Obstetrics and Gynecology 150: 200–204.PubMedGoogle Scholar
  18. Frank, R. T., 1931. The hormonal causes of premenstrual tension.Archives of Neurology and Psychiatry 26: 1053–1057.Google Scholar
  19. Gillman, J., 1942. The nature of subjective reactions evoked in women by progesterone with special reference to the problems of pre menstrual tension.Journal of Clinical Endocrinology and Metabolism 2: 157–160.CrossRefGoogle Scholar
  20. Haspels, A. A., 1981. A double-blind, placebo-controlled, multicentre study of the efficacy of dydrogesterone (Duphaston). In:Proceedings of the Sixth International Congress of Psychosomatic Obstetrics and Gynaecology, Berlin. MTP Press, Lancaster, England, pp. 81–92.Google Scholar
  21. Israel, S. L., 1938. Premenstrual tension.Journal of the American Medical Association 110: 1721.CrossRefGoogle Scholar
  22. Mansel, R. E., J. R. Wisbey, and L. E. Hughes, 1979. The use of Danazol in the treatment of painful benign breast disease: Preliminary results.Postgraduate Medical Journal 55(Supplement 5): 51.Google Scholar
  23. Moos, R. H., 1977.Menstrual Distress Questionnaire Manual. Stanford University School of Medicine, Stanford, CA.Google Scholar
  24. Munday, M., 1977. Progesterone and aldosterone levels in the premenstrual tension syndrome.Current Medical Research and Opinion 4: 16–22.CrossRefGoogle Scholar
  25. Muse, K., N. Cetel, L. Futterman, and I. S. Yen, 1984. The premenstrual syndrome: Effects of “medical ovariectomy.”New England Journal of Medicine 311: 1345–1349.PubMedCrossRefGoogle Scholar
  26. O’Brien, P.M.S., 1979. Endocrine Changes in Premenstrual Syndrome. M.D. Thesis, University of Wales.Google Scholar
  27. O’Brien, P.M.S., 1982. The premenstrual syndrome: A review of the present status of therapy.Drugs 24: 140–151.PubMedCrossRefGoogle Scholar
  28. Obrien, P.M.S., D. Craven, C. Selby, and E. M. Symonds, 1979. Treatment of premenstrual syndrome by spironolactone.British Journal of Obstetrics and Gynaecology 86: 142–147.CrossRefGoogle Scholar
  29. Pennington, V. M., 1957. Meprobamate (Miltown) in premenstrual tension.Journal of the American Medical Association 164: 638–640.PubMedCrossRefGoogle Scholar
  30. Preece, P. E. and R. E. Mansel, 1981. Management of breast pain using Efamol. Paper presented at the First Symposium on the Clinical Uses of Efamol and Essential Fatty Acids, London.Google Scholar
  31. Rees, W. L., 1953. Psychosomatic aspects of the premenstrual tension syndrome.Journal of Mental Science 99: 62.PubMedGoogle Scholar
  32. Sampson, G. A., 1979. Premenstrual syndrome: A double-blind controlled trial of progesterone and placebo.British Journal of Psychiatry 135: 209–215.PubMedCrossRefGoogle Scholar
  33. Smith, S. L., 1975. Mood and the menstrual cycle. In: E. J. Sachar (Ed.),Topics in Psychoendocrinology. Grune & Stratton, New York, NY, pp. 19–58.Google Scholar
  34. Studd, J.W.W. and A. L. Magos, 1983. Management of the premenstrual syndrome by subcutaneous implants of oestradiol.Proceedings of the 23rd British Congress of Obstetricians and Gynaecologists, Birmingham,p. 66.Google Scholar
  35. Tonks, C. M., 1975. Premenstrual tension.British Journal of Psychiatry, Special No. 9: 399–407.Google Scholar
  36. Wood, C. and D. Jakubowicz, 1980. The treatment of premenstrual symptoms with mefenamic acid.British Journal of Obstetrics and Gynaecology 87: 627–630.PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1987

Authors and Affiliations

  • P. M. S. O’ Brien
    • 1
  1. 1.Academic Department of Obstetrics and GynaecologyThe Royal Free HospitalHampstead, LondonEngland

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