Premenstrual Syndrome

Description

Alternative Names

Other Treatments

Some women have reported relief from pelvic pain after acupuncture or acupressure (a needle-less approach). Of particular interest is reflexology, a variant technique that uses manual pressure on acupuncture points on the ears, hands, and feet. In one study comparing this technique to a sham procedure, those who had true reflexology had significantly fewer PMS symptoms than did women in the other group.

Acupuncture, hypnosis and biofeedback are all alternative ways to control pain. Acupuncture involves the insertion of tiny sterile needles, slightly thicker than a human hair, at specific points on the body.

Chiropractic Treatments

One small study reported improvement in symptoms with the use of spinal manipulation and soft-tissue therapy two to three times a week in the week before menstruation. It was not clear, however, if the treatment was any more effective than a sham treatment. More research is needed.

Meditative Exercises

Meditative techniques include Yoga or other exercises that use meditation, promote relaxation, and reduce stress. They may be particularly helpful.

Phototherapy

Phototherapy, which uses fluorescent light up to 50 times more intense than ordinary light, is now a recommended treatment for seasonal affective disorder (SAD), which is a form of depression related to the reduction of sunlight in winter months. Women with SAD may have a higher prevalence of premenstrual dysphoric disorder, and some experts now believe that phototherapy may be useful for PMS-related depression. There are a few side effects, including headache, eyestrain, and irritability. Patients taking drugs for psoriasis or vitiligo, certain antibiotics, or antipsychotic drugs should not use light therapy.

Sleep Deprivation

Some studies have indicated that sleep deprivation during the late premenstrual phase may improve premenstrual dysphoric disorder in some women by correcting underlying disturbances of circadian rhythms. This involves sleeping only four hours during one night and making up for it the next. More research is needed on this interesting approach.

Herbal and Other So-Called Natural Remedies

A number of herbal remedies are used for PMS symptoms. Some of these products are discussed below. With a few exceptions, studies have not found herbal or other so-called natural remedies to be any more effective than placebo for relieving PMS symptoms. Additionally, they can be expensive. It is certainly possible that some herbal medicines may be helpful, but patients should always be wary of unproven claims for quick cures. In addition, it must be stressed none of these products are regulated for quality, effectiveness, or safety.

Evening Primrose. Some women have reported that taking evening primrose oil helped PMS. However, studies vary as to its effectiveness for PMS symptoms and two rigorous studies reported no benefit. It may be helpful for relieving breast symptoms.

Agnus Castus Fruit Extract (Chaste Tree Berry). Several studies are reporting that agnus castus fruit, also known as chaste tree berry (Vitex), may help alleviate PMS, particularly breast pain and tenderness, but also other symptoms. Some evidence suggests that the compounds in this substance reduce prolactin levels. Prolactin is the important hormone in breast milk production. Therefore, it may specifically help some women with irregular periods due to high levels of this hormone (a condition called hyperprolactinemia). If prolactin-suppression effects prove to be significant, however, the agent may also have important adverse effects as well, although to date women have reported only mild side effects. Until more is known, at this time it should not be used by women who wish to conceive or who are sexually active and not using a reliable form of birth control.

Flaxseed Oil. Flaxseed oil may help relieve breast pain and tenderness associated with menstruation.

Ginger Tea. Ginger tea is safe and may help in relieving mild nausea and other minor symptoms of PMS.

Krill Oil. In one study, a natural product derived from the krill fish (Neptune Krill Oil) is rich in omega-3 fatty acids and other chemicals has improved PMS symptoms and reduced menstrual cramps compared to omega-3 fatty acids alone.

Melatonin. Women with PMS appear to have lower levels of melatonin, a powerful hormone that regulates sleep. One small study that simulated air travel reported that melatonin was helpful in reducing stress in PMS women, but controlled studies are needed to determine any real benefit.

St. Johns Wort. St. Johns Wort (Hypericum perforatum) is an herbal remedy that may help some patients with mild to moderate depression. It is not clear, however, how significant the benefits are. Some--but not all--studies report that it is more effective than placebo. Notably, a 2002 study reported no differences between St. John's Wort and placebo for patients with moderate depression. A 2000 study on similar patients, however, reported that it was as effective as a tricyclic.

Even if studies were consistent, this herbal substance is not regulated and there is no guarantee of quality in any brands currently available. In fact, in a 2002 St. John's Word brand comparison only three products out of eight were within 10% of the active ingredient amounts claimed on their labels.

At this time, the following guidelines are recommended:

• People with severe depression should not take this remedy without a physician's guidance. Even those with mild depression should not use St. John's Wort without consulting a physician. Children and pregnant or nursing women should not take this substance.
• People should purchase brands only from well-established manufacturers until regulations have been established for this and other herbal remedies.
• Although no dose levels have been established, trials indicate that 300 milligrams taken three times a day may be effective. (Patients should check with a knowledgeable physician.)
• It takes between two and three weeks for the drug to have an effect.
• Early studies had suggested that the herbal substance might act in the same way as chemical MAO inhibitors, but the MAO-like activity of St. John's Wort appear to be minimal. Still, some experts suggest avoiding large amounts of foods and substances that have tyramine, such as red wine, meat, and aged cheese.
• It should not be combined with other antidepressants.

Side effects include nausea, dry mouth, allergic reactions, and fatigue, although, in general, side effects are quite uncommon. In one study, only 1.1% of patients discontinued the agent because of side effects. Some people have reported temporary nerve damage after sun exposure, specifically pain and tingling on sun-exposed areas although a 2001 study found that sun sensitivity reactions were low. There are also some laboratory studies that suggest high doses may impair fertility in men.

St. John's wort may increase the risk for bleeding when used with anti-clotting agents or with other natural or standard medications that thin blood, such as warfarin or high doses of vitamin E. They may interact with oral contraceptives in women.Notably the herbal agent appears to reduce the effectiveness of certain cancer chemotherapy agents and HIV treatments.