Relieving PMS
by Ellen Hale

Cramps aren't the only problem women suffer in their monthly cycles. For many, premenstrual syndrome (PMS) can be just as bothersome.

PMS occurs in the last 7 to 10 days of the menstrual cycle--called the luteal phase. The time at which these symptoms occur is very important because it's what allows doctors to track their cyclic nature and make a diagnosis.

While premenstrual syndrome remains a mysterious malady, there is growing recognition that it is a true physical syndrome, and there are a number of new treatments to help lessen its symptoms.

The American College of Obstetrics and Gynecology (ACOG) says from 20 to 40 percent of all women suffer some symptoms of PMS, which it defines as "a recurring cycle of symptoms that are so severe as to affect lifestyle or work." ACOG estimates that 5 percent of women have severely disabling PMS.

The variety of symptoms and combinations of symptoms are usually divided into four major groups, according to Lisa Rarick, M.D., medical officer in FDA's division of metabolism and endocrine drug products. Breast tenderness, swelling, weight gain, and bloating comprise one group of symptoms. A second group includes emotional changes such as depression, forgetfulness, crying, insomnia, and confusion. A third group involves headaches, food cravings (especially sweets), increased appetite, fatigue, and dizziness. The fourth group includes anxiety, nervous tension, mood swings, and irritability.

For the most part, PMS is alleviated by treating its symptoms. For example, for those who suffer from symptoms of water retention, diuretics may help. They are a component of many OTC medications for PMS. In 1988, FDA tentatively proposed that three OTC diuretics could be used in menstrual drug products (including those that treat PMS): caffeine, ammonium chloride, and pamabrom.

It is believed that caffeine may help relieve bloating and water retention because it acts as a mild diuretic, and that it also may help relieve the fatigue many women complain of in the premenstrual period. On the other hand, excessive amounts of caffeine may aggravate anxiety and tension, and some doctors think it may be associated with increased breast tenderness. Some over-the-counter medications for PMS combine several ingredients. One product, for example, contains pyrilamine maleate (an antihistamine approved for OTC use but not specifically for PMS), pamabrom and acetaminophen. Women should read the labels of OTC products and check with their doctors for advice on the best treatments for the specific PMS symptoms they have.

Some doctors believe women may be able to help themselves through the discomfort of PMS without pills by exercising, eliminating or cutting down on smoking, and changing their diets.

"I recommend eating small frequent meals because a lot of food causes blood sugar to swing up and down, and that may effect premenstrual problems," says M. Yusoff Dawood, M.D., director of the Division of Reproductive Endocrinology at the University of Texas Medical School in Houston.

To stem water retention, many doctors recommend reducing salt intake, and to reduce headaches, avoiding liquor. No scientific studies have proven that exercise can reduce PMS, but there is much anecdotal and indirect evidence that it does, doctors say.

"The idea is that exercise raises levels of beta endorphins, [which] have a positive effect on mood and behavior," says Michelle Warren, M.D., co-director of the Division of Reproductive Endocrinology at St. Luke's-Roosevelt Hospital in New York City. Moreover, she believes exercise may reduce water retention.

Vitamin B6, known as pyridoxine, is recommended by some doctors to relieve PMS, but studies on its effectiveness have been inconclusive, according to Dawood. Use of extreme doses of it have been associated with neurological problems.

For those whose PMS is unrelieved by most common treatments, more help is available. While not approved for these uses by FDA, some doctors prescribe birth control pills and use of progesterone suppositories (during the premenstrual phase) for PMS. Oral contraceptives prevent ovulation and therefore prevent the luteal phase from occurring. Although progesterone suppositories have proven no more successful than a placebo in controlled studies, because they seem to help some women, Warren believes they are worthwhile. Prescription painkillers, diuretics, tranquilizers, and antidepressants are also prescribed by physicians in severe cases.

Ellen Hale is a freelance writer in Washington, D.C.

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article syndicated from U.S. Food and Drug Administration:
http://www.fda.gov/bbs/topics/CONSUMER/CON00004.html
FDA Consumer Magazine Article