09 July 2010

PMS is a real and severe health issue for many women

Women with premenstrual syndrome (PMS), from mild to very severe (and severe PMS is described as having premenstrual dysphoric disorder or PMDD) have a number of symptoms which compromise and adversely affect their quality of life and the level this is affected depends on the level of symptoms experiences - the worse the symptoms, the more adversely the quality of life is affected.

Scientists have been looking at women with PMS and have come to the conclusion that women who experience PMS symptoms experience lowered quality of life as they cannot function properly (whether it is in their relationships, work, social life) and this causes increased medical costs through more visits to doctors and subsequent lab test. It also causes indirect costs to employers through lowered productivity when a woman experiences severe PMS symptoms and cannot function or think as effectively as she normally does when not in PMS.

Women with severe PMS symptoms, especially the mental symptoms of anxiety, depression, anger can be so impaired in their ability to function normally (when not in the time of PMS), that it can cause an impairment in interpersonal or workplace functioning.

Interpersonal conflicts are common for women with PMS and that can cause a great deal of unnecessary stress in a workplace or for a woman's interpersonal relationships, which if not treated effectively and continues to escalate unabated, can mean those relationships cease to exist and employment may go on to be terminated. This of course, compounds the issue and it becomes a vicious circle.

Women with PMS must seek effective treatment for the symptoms of PMS in order to maintain a better quality of life and in order not to suffer the symptoms of this, often, debilitating condition.

Your doctor can use a Premenstrual Symptoms Screening Tool (PSST) to help you determine how PMS symptoms are affecting your life.

There are adequate (and natural) ways to control PMS (and even the condition known as PMDD).

  1.  Choi D, Lee DY, Lehert P, Lee IS, Kim SH, Dennerstein L. The impact of premenstrual symptoms on activities of daily life in Korean women. J Psychosom Obstet Gynaecol. 2010 Mar;31(1):10-5
  2.  Freeman EWSondheimer SJ. Premenstrual Dysphoric Disorder: Recognition and Treatment. Prim Care Companion J Clin Psychiatry. 2003; 5(1): 30–39. Accessed 8 July 2010
  3. Mishell DR Jr. Premenstrual disorders: epidemiology and disease burden. Am J Manag Care. 2005 Dec;11(16 Suppl):S473-9. Accessed 8 July 2010
  4. Pearlstein T, Steiner M. Premenstrual dysphoric disorder: burden of illness and treatment update. J Psychiatry Neurosci. 2008 Jul;33(4):291-301. Accessed 8 July 2010

Antidepressants and oral contraceptives - dont work for PMDD

A recent study2 which reviewed data from studies dating from 1990 to 2008 to research those randomized, double-blind, placebo-controlled clinical trials of selective serotonin re-uptake inhibitors (SSRIs), a type of anti-depressant and combined oral contraceptives (COCs) to determine how much of an effect they had on women with symptoms of PMS and  symptoms of PMDD.

After reviewing the data, measurements and outcome of all of the large-scale studies, the authors of the review2 noted that once the placebo effect was discounted, the actual results showed that the percentage of women who had a beneficial outcome from using SSRIs or COCs was not much more than the women who did not have any benefit from using these medications. In other words, women who used SSRIs or contracetives had the same level of PMS/PMDD symptoms as women who did not use the medications.

The authors of the review2 also noted that around 40% of women with PMS/PMDD symptoms did not have a positive outcome from using the SSRIs medications - their symptoms did not improve. They also stated that treatment with COCs also does not substantially improve the symptoms in women with PMS/PMDD.

The authors of the review2 suggested that "additional alternative targeted treatment modalities need to be developed" for more adequate treatment of PMS/PMDD than is currently available.

Other studies recently suggest that anti-depressants don't help people with mild to moderate depression and as depression can be one of the symptoms of severe PMS/PMDD, that suggests again, quite clearly, that anti-depressants are not going to help women with severe PMS/PMDD symptoms either.

A recent review1,3 of a number of randomised studies of people using anti-depressants for depression found that there was little evidence that anti-depressants have an effect that is any different to a placebo for people with mild to moderate depression.  In other words, using anti-depressants and using placebos (no drug) have the same effect.

  1. Fournier JC, DeRubeis RJ et al. Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis. JAMA. 2010;303(1):47-53. Accessed 8 July 2010
  2. Halbreich U. Selective serotonin reuptake inhibitors and initial oral contraceptives for the treatment of PMDD: effective but not enough. CNS Spectr. 2008 Jul;13(7):566-72. Accessed 8 July 2010 
  3. Silverman E. Antidepressants Don’t Help Mild Depression: Study. Pharmalot online. 5 January 2010. Accessed 8 July 2010