WOMEN: MENSTRUAL PROBLEMS. TREATMENT FOR PMS
The best treatment for any health disorder is to eliminate its cause. With PMS we don’t know the cause, so treatment can only be ‘try it and see’, or measures to improve general health and reduce stress.
A baffling fact about many drag treatments for PMS is that if they are tested against a placebo, as many patients will improve on the placebo as on the real medication. Perhaps simply acceptance of the symptoms as being real (as they certainly are), encouraging a woman to discuss them and offering suggestions and hope for relieving them plays an important part in the treatment of PMS (as ill does in most illnesses).
As with many disorders, a sensible approach to general health helps to relieve symptoms: eat well; get enough sleep, rest and recreation; reduce stress; exercise regularly and make a point of enjoying life. Nevertheless, PMS of any severity will not be eliminated simply by a sympathetic hearing and advice about healthy lifestyle.
The following treatments have been tried for PMS.
Progestogens
Dr Katharina Dalton, British pioneer in the management of PMS, has been the most enthusiastic champion of the use of progesterone. She recommends pure progesterone in high doses by injection or suppository (it is inactive if taken by mouth) for 10-14 days before menstruation. The only two properly controlled studies of this treatment have shown that the active drag was no better than placebo, though both produced improvement.
Synthetic progestogens (progesteronelike hormones that can be taken by mouth) have been studied more, but the results of the various studies for the same treatment conflict. Dydrogesterone (Duphaston) is the only progestogen that has consistently given better results than the placebo.
Combined oral contraceptives
Many women notice that premenstrual symptoms disappear when they’re on the Pill (however a small number find that symptoms worsen). The effects of the Pill on PMS are unpredictable, but if contraception is needed it’s worth a try.
Antiprostaglandins
Prostaglandin inhibitors such as mefenamic acid (Mefic, Ponstan) have significantly reduced tension, irritability, depression, pelvic pain and headache for some women.
Evening primrose oil (EPO)
This has a good reputation for relieving premenstrual breast tenderness. One ingredient of EPO is converted to gamolenic acid, which changes the ratios of prostaglandins in the body – a possible explanation for its effects on breasts. There are conflicting results of studies on its value relieving other premenstrual symptoms. Some studies show good results: others show that it is no better than a placebo. (EPO shouldn’t be taken by any-: with a history of epilepsy, as it can I cause fits in epileptics.)
Bromocriptine This inhibits the production of prolactin. It can be used in the second half of the cycle to reduce premenstrual breast symptoms, but has little or no effect on fluid retention or psychological symptoms. It is a potent drug that can cause many side-effects. It is used only as a last resort to relieve severe premenstrual breast pain.
Diuretics It is widely believed that PMS is associated with, if not caused by, salt and water retention. However, some studies suggest that it’s more likely that the bloating and puffiness noticed by some women are due to redistribution of fluid rather than an increase in the total amount.
Most diuretics eliminate fluid by increasing the output of urine. These have no place in the treatment of PMS. The only diuretic that can be used with good reason is spironolactone, which corrects disorders of fluid distribution. Spironolactone has been shown to reduce the psychological symptoms of PMS better than placebo.
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