Diagnosis and Treatment of PMS
ACOG NEWS RELEASEEmbargoed until March 31, 2000
5:00 PM EST
ACOG ISSUES GUIDELINES ON DIAGNOSIS AND TREATMENT OF PMS
WASHINGTON, DC — To help guide its ob/gyn members in the diagnosis and treatment of a common ailment of reproductive-age women, The American College of Obstetricians and Gynecologists (ACOG) today issued a practice bulletin on Premenstrual Syndrome (PMS). The new document addresses the prevalence of PMS as well as recommended treatment options based on a review of the scientific evidence and expert consensus.
Although as many as 85 percent of menstruating women report one or more symptoms of PMS, only 5 to 10 percent of women experience symptoms severe enough to be debilitating. Symptoms include, among others, abdominal bloating, irritability, mood swings, headache, weight gain, fatigue, food cravings, tension, and breast swelling. Symptoms and discomfort level vary from woman to woman, but PMS affects women from all cultures and socioeconomic levels. Specific symptoms may differ by culture.
While the exact cause of PMS still is not completely understood, it appears that the hormones progesterone, estrogen and testosterone are involved. Changes in the level of serotonin, a brain chemical, also appear to be related to PMS. Symptoms appear after ovulation, about day 14 of a woman’s cycle, and disappear two weeks later as a woman’s period starts.
According to ACOG, a diagnosis of PMS should include: symptoms consistent with PMS; restriction of these symptoms to the luteal phase (last 2 weeks of the menstrual cycle); impairment of some facet of the woman’s life; and exclusion of other disorders. ACOG also recommends that a diagnosis of PMS be based on diaries kept by women charting their symptoms, preferably for two to three consecutive months.
Reviewing the diaries is necessary since only a small portion of women who visit a doctor for evaluation and treatment of PMS actually have it. This is because many other medical conditions are worsened in the late luteal or menstrual phase of the cycle (known as “menstrual magnification”). The most common disorders affected by menstrual magnification that may be mistaken for PMS include depression, migraine headaches, seizure disorders, irritable bowel syndrome, asthma, chronic fatigue syndrome, and allergies. Symptoms of these disorders are present throughout the menstrual cycle, however, and help distinguish them from PMS.
ACOG recommends lifestyle changes such as aerobic exercise, a complex carbohydrate diet, and/or nutritional supplements such as calcium, magnesium, and vitamin E to help resolve PMS symptoms. Serotonin selective reuptake inhibitor (SSRIs) antidepressants have been shown effective and may be useful for severe PMS. Alprazolam, an antianxiety medication, may be potentially useful for some women with severe symptoms, but should be carefully considered due to side effects and possible addiction. Gonadotropin-releasing hormone (GnRH) agonist treatment to prevent ovulation has been shown to be useful, but the long-term side effects and cost limit its use to those women with severe symptoms who are unresponsive to other treatments.
Oral contraceptives have been widely prescribed as a treatment for PMS, but there is little data to support their effectiveness. The bulletin advises that oral contraceptives may be considered if symptoms are mostly physical but may not be effective if mood symptoms are primary.
Spironolactone, available by prescription, is the only diuretic that has been shown to be of benefit for fluid-retention. The use of alternative treatments such as natural progesterone, primrose oil, and vitamin B6 have either been shown to be ineffective or to be only of limited benefit in treating specific symptoms.
* * * ACOG’s 48th Annual Clinical Meeting will be held in San Francisco, CA, at the Moscone Center, May 22-24, 2000. Reporters interested in attending should contact the ACOG Office of Communications at (202) 484-3321 or communications@acog.org. Preregistration is required; deadline is May 15th. * * *
The American College of Obstetricians and Gynecologists is the national medical organization representing nearly 40,000 physicians who provide health care for women.
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