Oops! You're not crazy after all--the new PMS study

In 1987, premenstrual syndrome (PMS) was officially designated a psychiatric disorder by the American Psychiatric Association. The move was controversial at the time because it seemed to validate the dismissive its all in your head response many women with PMS had already been receiving from their gynecologists. Because the predominant symptoms are mood changes (e.g., sadness, anxiety) PMS is assumed to be an emotional disorder, but a new study has identified a biological cause. The findings suggest that the occurrence of [PMS] symptoms represents an abnormal response to normal hormonal changes, according to the lead investigator, Peter J. Schmidt, M.D., and colleagues at the National Institutes of Health (New England Journal of Medicine, 22 January 1998).

Researchers have long known that PMS is triggered by ovarian hormones. In addition to the behavioral manifestations like irritability and fatigue, women often experience physical symptoms like breast tenderness and fluid retention, which usually last for about a week be-fore the onset of the menstrual period. About 2.5% of women of childbearing age have severe PMS. Earlier research had already demonstrated that the symptoms can be eliminated by giving women the rather drastic treatment of drugs that temporarily induce menopause.

The new study used the drug leuprolide (brand name: Lupron) to produce a chemical menopause in ten women with PMS. Then they were given the usual female hormones (estrogen or progesterone) back in drug form to see what happens. All were randomly assigned to take an inactive placebo for four weeks and the hormone drugs for another four weeks. Both the hormones and the placebos were in look-alike tablet form, thus the participants had no idea when they were taking the active hormone drug. At the end of the study, the symptoms of the ten participants were compared with those of ten other women without PMS. When the women with PMS took hormones, their symptoms increased considerably. But no symptoms occurred when taking a placebo while their hormones were suppressed with leuprolide. Taking hormone drugs had no effect on the ten women without PMS.

According to Dr. Schmidt, the study shows that women with severe PMS respond differently to normal hormone levels. Though this is a small-scale study that requires confirmation by other researchers, it may change the medical view of PMS and consequently how it will be treated. PMS is not, as was previously thought, the result of an excess or a deficiency of hormones.

Current Treatments Disappointing
When PMS dominated the health news media over a dozen years ago, the disorder was treated with progesterone or oral contraceptives. Though no evidence supported these widely prescribed treatments, PMS clinics sprang up around the country and were viewed by some as hormone mills. Eventually, well-designed clinical trials proved these hormonal therapies to be ineffective. More recently, Prozac has been prescribed to women with PMS because a 1995 study showed improvement with this antidepressant which raises brain levels of serotonin. While this suggests a relationship between PMS and brain chemistry, Prozacs efficacy decreased considerably after four months.

A pitch for newer and better drugs was made in an editorial that accompanied the new study. Dr. Joseph F. Mortola noted that there was a marked worsening of PMS symptoms when women took estrogen alone. ...There is now sufficient evidence to suggest that estrogen, never before seriously considered as a hormone with negative mood effects, may indeed play a part in the symptoms of PMS. He calls for the development of entirely new treatment strategies based on drugs or hormones that block estrogens effect on the brain.

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By Maryann Napoli

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