The medical approach

The medical treatment of premenstrual syndrome either concentrates on symptom relief or on the manipulation of the hormonal axis. As symptom relief is not an acceptable option for many women and hormonal manipulation frequently carries many unwanted risks, many medical practitioners adopt a conservative approach which comprises some or a number of the recommendations listed below in ‘A natural approach’, and suggest drug therapy only for those women who do not respond to these safer methods.

Many hormonal medications are used in PMS: some to stop ovulation, others to improve the hormonal profile. These drugs include the Pill, GnRH agonists, Danazol, oestradiol patches or implants, progestogens and progesterone. Surgery to remove the ovaries is sometimes suggested as a radical last option; however, it is unacceptable to most women to trade the symptoms of premenstrual syndrome for those of premature menopause as well as the risk of loss of bone density.

Other common treatments are the diuretics; but these drugs will not improve all symptoms of premenstrual syndrome and have been shown to be useful only for those women who gain weight premenstrually. A series of pre- and post-menstrual weight measurements is necessary to identify those women with weight gain who qualify for the use of diuretics, and those women who have bloating from other causes.

Prostaglandin-related treatments are also suggested. These include mefenamic acid (Ponstan) and naproxen sodium (Naprogesic, Naprosyn, Anaprox), as well as evening primrose oil. These types of treatments are more successful for the treatment of symptoms related to pain than for mood changes, and therefore have limited application. Evening primrose oil is discussed on site and the prostaglandin-inhibiting drugs on site.

Psychotropic drugs (anti-depressants and anxiolytics) have been the subject of intensive research since 1994 when psychiatrists defined premenstrual dysphoric disorder and became involved in the treatment of premenstrual mood changes. One type of anti-depressant drug, the selective serotonin-reuptake inhibitors (SSRIs) accounted for only 2 per cent of prescriptions for premenstrual syndrome in 1993 but rose to over 16 per cent by 1998, becoming the second most commonly recorded treatment for premenstrual syndrome (PMS). The effects of the common classes of psychotrophic drugs on premenstrual syndrome — the tricyclic antidepressants, the SSRIs and the anti-anxiety drugs (anxiolytics) are described on site.

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