Premenstrual syndrome (PMS)

Birth control medications are now used for treating the severest type of premenstrual syndrome – premenstrual dysphoric disorder (PMDD). The first such drug that was approved by FDA is Yaz. It was clinically proved that Yaz is able to relief PMDD symptoms with efficiency not less than 50%. These results motivated FDA for its approval.

What is more, Yaz showed its effectiveness in removing both physical and emotional disorders caused by PMDD, positively influencing on daily activity, relations with people and emotional stability.

Yaz, as other hormonal birth control medications, contains estrogen and the unique form of progestin. Its unique characteristics are very helpful in fighting PMDD, if to follow its 24-day intake schedule, according to the latest release from Berlex Inc., the American representative of Yaz manufacturer (Schering).

Andrea Rapkin, MD from UCLA’s David Geffen School of Medicine, reports: “Yaz is able to solve both problems. It combines facilities for effective contraception for preventing unwanted pregnancy and for reducing the PMDD impact on female organism”.
It is common for the most of women to experience PMS problems, but PMDD occurs only in 5% of cases. PMDD has the strongest symptoms that impact women making them unable to do their everyday activities.

PMDD: Aggressive PMS Successor

For the most of doctors and patients PMDD is something like PMS squared. For diagnosing PMDD women has to experience at least five of the symptoms described below:

· Mood swings, frequent wish to cry

· The feel of apathy, sadness or hopelessness

· Increased irritability worsening relationships with people around

· Tenseness or anxiety with no reason

· The feel of losing control

· Shortage of energy

· The loss of interest to things and people that usually were interesting

· Appetite changes like intense desire to eat, overeating

· Problems with attention and its concentration, slow mental work

· Slumber problems: not getting enough sleep or excessive sleeping

· Physical disorders like headaches, pains in muscles and joints, swelling, breast tenderness, increase of weight, etc.

It is required to experience one of the first four symptoms to give a diagnosis of PMDD. As a rule these symptoms appear the week before periods and totally disappear in a couple of days after they start.

PMDD is very hard to stand, that is why doctors often prescribe the whole complex of medications for its treatment, including antidepressants, hormonal drugs, water pills, vitamins. Nowadays many kinds of birth control pills are used to treat PMDD, but Yaz was the first one that received FDA approval.

The most popular side effects caused by Yaz are headaches and pain in breasts.

The PMDD symptoms are successfully obviated by several medical therapies described below.

Antidepressants (SSRIs)

Several medicines from the group of selective serotonin reuptake inhibitors (SSRIs) are successfully used to relief the symptoms of PMDD by removing their reason. These medications influence on human organism by influencing on the level of serotonin in the brain.

SSRIs whose effectiveness has been proved include the following drugs:

- sertraline (Zoloft)

- fluoxetine (Prozac, Sarafem)

- paroxetine (Paxil)

- citalopram (Celexa)

SSRI medicines are reported to be very effective therapy, as about 75% of women who used SSRIs felt significant alleviation of symptoms. Side effects, such as nausea, headaches and uneasiness are experienced by 15% of women who take SSRIs. As a rule SSRI drugs are prescribed for continuous intake or taking only during 14-days of the luteal phase. Other groups of antidepressants, as well as lithium medicines (like Lithobid) haven’t shown their effectiveness in PMDD prevention therapy.

Oral contraceptives and GnRH agonists

Other ways of PMDD treatment are avoidance of ovulation and ovarian hormones control. For this purpose oral contraceptives are used. OCPs, birth control pills change the menstrual cycle by inhibiting the ovulation process.
Gonadotropin-releasing hormone analogs (GnRH analogs or GnRH agonists) influence on hormones production and are widely used in anti-PMDD therapy. Suppressing estrogen production by influencing on pituitary gland as inhibitor of regularly hormones secretion causes the stoppage of menstrual periods. GnRH agonists are used in one of two available forms – injection or nasal.

GnRH agonists used in PMDD treatment include:

- leuprolide (Lupron)

- goserelin (Zoladex) and

- nafarelin (Synarel)

There are a whole variety of side effects caused by GnRH agonist medicines: vaginal dryness, occasional bleedings, mood swings, tiredness, hot flashes and osteoporosis (the loss of bone strength). These side effects are caused by the shortage of female hormones and can be minimized by additional intake of estrogen and progesterone.

Danazol (Danocrine)

This synthetic medicine influences on hormone balance, increasing the content of androgen (male hormone) and decreasing estrogen content in the organism. Such hormonal environment suppresses ovulation and inhibits ovarian estrogen production. Danazol is effectively used to prevent PMDD symptoms, but in 75% of cases the treatment is accompanied with various side effects including:

- Weight growth,

- oedema,

- breast size decreasing,

- male-like hair growth

- voice mutation (deeping),

- acne and oily skin,

- headaches,

- libido changes,

- mood swings.

These side effects except voice mutations are convertible. But returning to the normal state can take months or even years. That is why Danazol (Danocrine) is used only when other medications are helpless. The intake of these drugs is forbidden for women with certain liver, kidneys and heart disorders.

Other treatments

Alternative therapy of PMDD include chasteberry extract (agnus castus fruit), special diets with additional intake of calcium, B6 and E vitamins. These therapies have shown their effectiveness in relieving the PMS/PMDD symptoms.