Premenstrual syndrome; a double-blind controlled trial of desipramine and methylseopolarnine (original) (raw)

Efficacy of progesterone and progestogens in management of premenstrual syndrome: systematic review

BMJ, 2001

Objective To evaluate the efficacy of progesterone and progestogens in the management of premenstrual syndrome. Design Systematic review of published randomised, placebo controlled trials. Studies reviewed 10 trials of progesterone therapy (531 women) and four trials of progestogen therapy (378 women). Main outcome measures Proportion of women whose symptoms showed improvement with progesterone preparations (suppositories and oral micronised). Proportion of women whose symptoms showed improvement with progestogens. Secondary analysis of efficacy of progesterone and progestogens in managing physical and behavioural symptoms. Results Overall standardised mean difference for all trials that assessed efficacy of progesterone (by both routes of administration) was − 0.028 (95% confidence interval − 0.017 to − 0.040). The odds ratio was 1.05 (1.03 to 1.08) in favour of progesterone, indicating no clinically important difference between progesterone and placebo. For progestogens the overall standardised mean was − 0.036 ( − 0.014 to − 0.060), which corresponds to an odds ratio of 1.07

PMS treatment approaches and progesterone therapy

Psychosomatics, 1985

Two hundred thirty-nine patients met the diagnostic criteria for premenstrual syndrome (PMS) or possible PMS and were first treated with multiple nonhormonal approaches. After six weeks, 35% reported good improvement. Of 107 unimproved patients who subsequently received progesterone therapy, 53% reported good improvement at the six-month follow-up. This report suggests the range of treatment responses among women who seek treatment for premenstrual symptoms, but placebo-controlled study is essential. It appears useful to provide conservative treatment initially, with the addition of hormonal therapies only when symptoms are not reduced. program to an initial nonhormonal treatment regimen and to subsequent progesterone therapy that was prescribed only after symptoms did not improve with the initial regimen. These data suggest the extent of symptom relief, using nutritional and educational approaches and possible progesterone therapy, as practical guidance until placebo-controlled studies can definitely describe treatment effectiveness.

The Assessment of the Symptoms of Premenstrual Syndrome and their Response to Therapy

British Journal of Psychiatry, 1981

SummaryThe symptoms of premenstrual syndrome should be rated daily, or at frequent intervals throughout the menstrual cycle. Self-rating is usually most feasible and separate rating of differing symptom groups is important, as symptoms differ in their response to therapy. Daily scores should be analysed to assess periodicity, either by subdividing the cycle into phases or by using the least mean square method of fitting sine waves. Standardized scores enable data to be compared across cycles. In a clinical trial it is important to include an untreated cycle to assess whether the subject has premenstrual syndrome and as a baseline with which to compare treated cycles. Allowance should be made for a carry-over effect and for high placebo response. One solution is to use a change-over design balanced for carry-over effects. The criteria used to define a patient should be stated.

Diagnosis, pathophysiology and management of premenstrual syndrome

The Obstetrician & Gynaecologist, 2015

An overview of current information available on premenstrual syndrome (PMS), which is in accordance with the new RCOG Green-top Guideline. Definition of PMS and explanation about the different types of premenstrual disorders. How to accurately diagnose PMS. Discussion about various treatment options available in accordance with the current literature. Learning objectives Develop an understanding of the pathophysiology behind PMS. How to diagnose PMS accurately and understand the different classifications of PMS. How to treat PMS, including the different treatment options available and discussion about side effects and benefits. Ethical issues Discussion about the long-term risks of GnRH analogue use, and the impact of long-term estrogen deficiency following a bilateral salpingoophorectomy. Misdiagnosed PMS in patients with underlying psychiatric and medical conditions.

Treatment of Premenstrual Syndrome with Progesterone in Women with Polycystic Ovary Syndrome

Gynecology & Obstetrics, 2013

Introduction: Premenstrual Syndrome (PMS) is defined as a group of disorders characterized by emotional and physical symptoms that occur in the luteal phase of the menstrual cycle and subside following menstruation. The reported prevalence of severe PMS is variable between 3% and 24%. Etiology of PMS remains unknown but cyclical ovarian activity and the effect of estradiol and progesterone on the neurotransmitters serotonin and gammaaminobutyric acid appear to be key factors. One hypothesis that the cause of PMS is the deficiency of progesterone and its derivatives. Polycystic Ovary Syndrome (PCOS) is characterized with chronic anovulation and oligo-ovulation. Due to this there is a distinct deficiency of progesterone and its derivatives in PCOS. The aim of this study was to investigate the efficiency of progesterone therapy for PMS in woman with PCOS. Materials and methods A randomized double blind controlled trial was performed on 60 women with PCOS and PMS. In the study group (progesteron group = group A, n=30), progesteron in a total amount of 300 mg was prescribed for a per day basis on three times a day, and in the control group (placebo group=group B, n=30) placebo capsules, which were completely similar to progesteron capsules were prescribed from day 15 to day 25. The severity and duration of symptoms were compared in both groups before treatment and 3 months after the beginning of treatment with Visual Analog Scala (VAS). Participants were requested to answer questions about their recurrent experience of 16 symptoms during the premenstrual phase. Data were analyzed using the Statistical Package for Social Science (SPSS, version 15.0). Results: We investigated 60 females (mean age progesterone group / placebo group= 26.6 ± 2,5/ 27 ± 1,8years; range = 18-35 years). Two or more premenstrual symptoms were detected in 95.5% of the participants. The most frequent symptoms are depression, anxiety, abdominal bloating, mood swings, breast tenderness. Statistical significant decline was seen in progesterone treatment group in depression, irritablity, anxiety, mood swing, abdominal bloating, sleeplessness, felt hopeless, breast tenderness, less interest in usual activities symptoms. Conclusion: In this study comparing progesterone therapy with placebo for PMS in women with PCOS, we found that women had much lower depression, irritability, anxiety, mood swing, abdominal bloating, sleeplessness, felt hopeless, breast tenderness, less interest in usual activities symptoms during progesterone treatment.

The pathophysiologic background for current treatments of premenstrual syndromes

Current psychiatry reports, 2002

Multiple hypotheses on the etiology of premenstrual syndromes (PMS) that have been proposed during the past 70 years have led to a multitude of treatment modalities. During the past two decades, the following two classes of pharmacologic interventions have emerged: hormonal interventions--mostly suppression of ovulation; and neurotransmitter's activity stimulation--mostly by specific serotonin reuptake inhibitors. These treatment modalities are based on the hypothesis that the etiology and pathophysiology of PMS are related to ovulation-related luteal activity of gonadal hormones, and their interaction with serotonin and other neurotransmitters. Two other components of the pathophysiology of PMS--the genetic propensity and the dynamically evolving-vulnerability--have not yet been addressed for treatment. Environmental inputs to pathophysiology, which are not discussed here, have been addressed by attempts at changes of lifestyle, coping style, and environment.

Progesterone treatment of premenstrual tension—a double blind study

Journal of Psychosomatic Research, 1985

Fifteen women with moderate to severe premenstrual symptoms, defined and graded according to a recently developed scoring system, took part in a double blind study of the effect of progesterone on premenstrual symptoms. The dosage was 100 mg progesterone twice daily delivered in vaginal pessaries. The women were improved with a statistically significant decrease in their scores by progesterone as well as by placebo treatment. There was no statistically significant difference between the two regimes.

Premenstrual syndrome and its psychiatric ramifications

Annals of Saudi medicine

Premenstrual syndrome and its psychiatric ramifications To the Editor: The article by Drs. Perveen Rasheed and Latifa Saad Al-Sowailem is interesting and the first of its kind that describes the prevalence and predictors of premenstrual syndrome in Saudi Arabia.1 However, we have reviewed the literature on premenstrual syndrome [PMS] and premenstrual dysphoric disorder [PMDD].2 Further, we have also reported five cases of PMS and its psychological connections to premenstrual dysphoric disorder.3 In a related development, Al-Habeeb also briefly reviewed the pertinent data and reported a case of premenstrual manic disorder, and based on four reported cases in the world literature, proposed tentative research diagnostic criteria.4 We observed that the two premenstrual syndromes with specific differentiating symptoms were etiologically attributed best to the dysregulation of central serotonergic and gabaergic systems and the noxious sex steroid hormonal milieu during normal cyclical ovulation. Further, the women with these syndromes, who need proper assessment, tests, and a correct diagnosis, respond effectively to selective serotonin-reuptake inhibitors, gonadotrophin-releasing hormone agonists, a novel contraceptive pill-Yasmin, cognitive-behavior therapy, lifestyle changes, and in addition, placebo. The oral contraceptive pill-Yasmin contains low-dose (30 microg) ethinylestradiol (EE) combined with a new progestogen, drospirenone (3 mg) (DRSP) and it offers better clinical efficacy for PMS/PMDD as a result of the unique pharmacological profile of this progestogen, which is a 17alpha-spirolactone derivative with antimineralocorticoid and antiandrogenic activity. Notably, DRSP resembles endogenous progesterone. Unlike other oral contraceptives, it has very minimal effects on skin, appetite, food craving, mood changes

The premenstrual syndrome: A brief history

Social Science & Medicine, 1995

This paper describes the origins and development of the modern concept of premenstrual syndrome (PMS). Symptoms associated with the premenstrual phase of the menstrual cycle have been acknowledged by physicians and in the general culture for little more than 60 years, while the notion that they define a clinical syndrome is exactly 40 years old. These symptoms are experienced as being primarily psychological (with emotional, somatic and behavioural components), their aetiology is as yet not known, their prevalence varies widely across different cultural groups, and they appear to respond to inactive placebos as effectively as to active preparations. However, the empirical basis for PMS is unclear, and the very use of the term 'syndrome' in this context has a number of connotations about which at least some researchers are exceedingly sceptical,