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
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,
"The idea is that exercise raises levels of beta endorphins, [which] have
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,
antidepressants are also prescribed by physicians in severe cases.
is a freelance writer
in Washington, D.C.
syndicated from U.S.
Food and Drug Administration:
FDA Consumer Magazine Article