Abstract
Persistent and bothersome somatic and mental complaints occurring in the premenstrual
phase in women, referred to as the premenstrual syndrome (PMS) or premenstrual dysphoric
disorder (PMDD), affect from 3 to 40% of women, depending on their severity. This
paper presents a diagnostic and therapeutic algorithm based on current data and own
experience. The etiology of PMS is still unclear, but sex steroids produced by the
corpus luteum of the ovary are thought to provoke symptoms, as the cyclicity disappears
in anovulatory cycles due to several reason, e.g. functional hyperprolactinemia. PMS
symptoms are largely affected by the serotonin system as well as the gamma-aminobutyric
acid (GABA) in the central nervous system (CNS), in association with the effect of
progesterone metabolites, e.g. allopregnenolon. The etiology of PMS is multifactoral,
involving behavior, diet, alcohol consumption, smoking, and physical activity. For
these reasons, non-medical therapy, including modification and supplementation of
the diet, relaxation techniques, and increased physical activity, plays a significant
role. Several pharmacological treatments appear to be effective. The therapeutic modality
depends on the kind of hormonal disturbances and involves drugs inhibiting the secretion
of prolactin, re-uptake of serotonin, or inhibition of ovulation. The beneficial effects
of Vitex agnus castus (VAC) therapy in women with PMS encourage further long-term randomized trials comparing
standard medical treatment modalities.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to MaturitasAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Premenstrual syndrome.in: Shaw R.W. Soutter W.P. Stanton S.L. Gynecology. 2nd ed. Churchill Livingstone, Edinburgh1993: 359-372
- Premenstrual syndrome: diagnosis and treatment experiences.J Women Health. 1998; 7: 893-907
- Premenstrual syndrome.N Engl J Med. 1991; 324: 1208-1210
ACOG (American College of Obstetricians and Gynecologist). Premenstrual syndrome. ACOG Practice Bulletin; 15 April 2000.
- Estimating direct and indirect costs of premenopausal syndrome.J Occup Environ Med. 2005; 47: 26-33
- Diagnostic and statistical manual of mental disorders.4th ed. (DSM-IV). American Psychiatric Association, Washington, DC1994 (p. 715–8)
- Premenstrual syndrome pathophysiologic considerations.N Eng J Med. 1998; 338: 256-257
- Incidence of premenstrual syndrome and remedy usage: a national probability sample study.Altern Ther Health Med. 1998; 4: 75-79
- Interactions between the hypothalamic-pituitary-adrenal axis and the female reproductive system clinical implications.Ann Intern Med. 1998; 129: 229-240
- The role of hormones and hormonal treatments in premenstrual syndrome.CNS Drugs. 2003; 17: 325-342
- A review of treatment of premenstrual syndrome and premenstrual dysphoric disorder.Psychoneuroendocrinology. 2003; 28: 39-53
- Changes in plasma hormones across the menstrual cycle in patients with menstrually related disorder and in control subjects.Am J Obstet Gynecol. 1998; 158: 5-11
- Efficacy of progesterone and progestogens in management of premenstrual syndrome: systemic reviews.BMJ. 2001; 323: 776-780
- Neuroendocrinology of premenstrual syndrome.Clin Obstet Gynecol. 1992; 35: 612-628
- The neurosteroids pregnenolone and pregnenolone-sulfate but not progesterone, block Ca2+ currents in acutely isolated hippocampal CA1 neurons.Life Sci. 1991; 49: PL235-PL239
- Allopregnanolone concentrations and premenstrual syndrome.Eur J Endocrinol. 2000; 142: 269-273
- Differential effects of progestins on the brain.Maturitas. 2003; 46: S71-S75
- The effect of low dose of alcohol on allopregenenolone serum concentrations across the menstrual cycle in women with severe premenstrual syndrome and controls.Psychoneuroendocrinology. 2005; (January 23: Epub ahead of print)
- Premenstrual symptomatology and alcohol consumption in college women.J Stud Alcohol. 2004; 65: 464-468
- Clinical significance of serum prolactin levels in cyclic mastalgia.in: Peters F. An update of cyclic mastalgia. Parthenon Publishing Group, New Jersey1988: 31-34
- Cyclic mastalgia-disease or not disease.in: Peters F. An update of cyclic mastalgia. Parthenon Publishing Group, New Jersey1988: 11-15
- Behandlung zyklusabhaengiger Brustschmerzen mit einem Agnus castus-haltingen Arzneimittel-Ergebnisse einer randomisierten, plazebokontrollen Doppelblindstudie.Geburts und Frauenheilk. 1997; 57: 569-574
- Auf der Suche nach dopaminergen Substanzen in Agni-cast-fructus-Praeparaten: Warum eigentlich?.Zeithschrift fuer Phytotherapie. 1999; 20: 150-152
- Chaste tree (Vitex agnus castus)—pharmacology and clinical indications.Phytomedicine. 2003; 10: 348-357
- Clinical aspects of breast benign disease.Polish J Endocrinol. 1997; 2 (Suppl. 1): 51-57
- Therapeutic affect of bromocriptine on patients with benign breast disease.in: Recent research on gynecological endocrinology. vol. 1. The Parthenon Publishing Group, Lancs, NJ1988: 647-652
- Vitex agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. Results of a randomized placebo-controlled double-blind study.Drug Res. 1993; 43: 752-756
- Alteration of platelet serotoninergic mechanisms and monoamine oxidase activity in premenstrual syndrome.Biol Psychiatry. 1988; 24: 225-233
- Modulation be estradiol of serotonin receptors in brain.J Neurosci. 1982; 2: 199-205
- Pre-menstrual syndrome: a new concept in its pathogenesis and treatment.Med Hypotheses. 2004; 62: 130-132
- An open-label, multicenter study to evaluate Yasmin, a low-dose combination oral contraceptive containing drosperinone, a new progestagen.Contraception. 2000; 61: 105-111
- An integrative medicine approach to premenstrual syndrome.Am J Obstet Gynecol. 2003; 188: 56-65
- Obesity as a risk factor for premenstrual syndrome.J Psychosom Obstet Gynecol. 2005; 26: 33-39
- Insulin sensitivity and premenstrual syndrome Eur.Arch Psychiatry Clin Neurosci. 2004; 254: 326-329
- Effect of low-fat diet on hormone levels in women with cystic breast disease.J Natl Cancer Inst. 1987; 78: 623-626
- Calcium and Vitamin D intake and risk of incident premenstrual syndrome.Arch Intern Med. 2005; 165: 1246-1252
- Premenstrual dysphoric disorder: current status of treatment.Swiss Med Wkly. 2002; 123: 574-578
- Menstrual disturbances.in: Skałba P. Gynecological endocrinology. Wydawnictwo Lekarskie PZWL, 1998: 236-277
- Premenstrual syndrome as predictor of menopausal symptoms.Obstet Gynecol. 2004; 103: 960-966
- Diagnosis of premenstrual syndrome by a simple, prospective, and reliable instrument: the calendar of premenstrual experiences.Obstet Gynecol. 1990; 76: 302-307
- Recent and future advances in the treatment of PMS, PMDD and menopause.Drugs. 2001; 4: 1341-1373
- Secondary amennorhea, diagnostic and therapy. An attempt to create the standard.Adv Clin Exp Med. 2004; 13: 135-139
- Fructus agni casti and bromocriptine for treatment of hyperprolactinemia and mastalgia.Int J Obstet Gynecol. 2004; 85: 292-293
- Traditional herbalists prescriptions for common clinical conditions: a survey of members of the UK National Institute of Medical Herbalists.Phytother Res. 1998; 12: 369-371
- Prescribing patterns in premenstrual syndrome.BMC Women's Health. 2002; 2: 1-8
- Herbs commonly used by women. An evidence-based review.Am J Obstet Gynecol. 2003; 188: 44-55
- Premenstrual syndrome. A natural approach to management.Clin Nutr Insights. 1997; 5: 1-8
- Evidence for estrogen receptor beta-selective activity of Vitex agnus castus and isolated flavones.Planta Med. 2003; 69: 945-947
- The complete German Commission E monographs: therapeutic guide to herbal medicines.American Botanical Council, Austin, TX1998 (p. 1694)
- Premenstrual syndrome: treatment with a phytopharmaceutical.Therapiewoche Gynekol. 1992; 5: 60-68
- Efficacy of progesterone and progestagens in management of premenstrual syndrome: systemic review.BMJ. 2001; 323: 776-780
- Efficacy of selective serotonin-reuptake inhibitors in premenstrual syndrome, a systematic review.Lancet. 2000; 365: 1131-1136
- Psychosocial functioning in women with premenstrual dysphoric disorder before and after treatment with Sertraline or placebo.J Clin Psychiatry. 2000; 61: 101-109
- Luteal phase administration of agents for the treatment of premenstrual dysphoric disorder.CNS Drugs. 2004; 18: 453-468
- An open-label, multicenter study to evaluate yasmin, a low-dose combination oral contraceptive containing drospirenone, a new progestogen.Contraception. 2000; 61: 105-111
Article info
Publication history
Published online: July 16, 2006
Identification
Copyright
© 2006 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
