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Bennett DL, Buckley A, Lee MV. Fibrocystic Change. Radiol Clin North Am 2024; 62:581-592. [PMID: 38777535 DOI: 10.1016/j.rcl.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Fibrocystic changes are commonly seen in clinically symptomatic patients and during imaging workup of screening-detected findings. The term "fibrocystic changes" encompasses a broad spectrum of specific benign pathologic entities. Recognition of classically benign findings of fibrocystic changes, including cysts and layering calcifications, can prevent unnecessary follow-ups and biopsies. Imaging findings such as solid masses, nonlayering calcifications, and architectural distortion may require core needle biopsy for diagnosis. In these cases, understanding the varied appearances of fibrocystic change aids determination of radiologic-pathologic concordance. Management of fibrocystic change is typically conservative.
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Affiliation(s)
- Debbie L Bennett
- Department of Breast Imaging, Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Boulevard, Box 8131, St Louis, MO, USA.
| | - Arianna Buckley
- Department of Breast Imaging, Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Boulevard, Box 8131, St Louis, MO, USA
| | - Michelle V Lee
- Department of Breast Imaging, Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, 510 South Kingshighway Boulevard, Box 8131, St Louis, MO, USA
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2
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Höller M, Steindl H, Abramov-Sommariva D, Kleemann J, Loleit A, Abels C, Stute P. Use of Vitex agnus-castus in patients with menstrual cycle disorders: a single-center retrospective longitudinal cohort study. Arch Gynecol Obstet 2024; 309:2089-2098. [PMID: 38393671 PMCID: PMC11018691 DOI: 10.1007/s00404-023-07363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/24/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE To evaluate clinical characteristics, quality of life (QoL) and effectiveness in patients with menstrual cycle disorders (MCDs) including abnormal uterine bleeding, dysmenorrhea and mastodynia/mastalgia related to premenstrual syndrome taking the Vitex agnus-castus (VAC) products Cyclodynon® or Mastodynon® in a real-world setting. METHODS A single-center retrospective longitudinal cohort study (3 ± 1 months), using data obtained from healthcare data archive and telephone interviews. The main study variables were changes in bleeding, menstrual pain, breast tenderness and patients' QoL. RESULTS Data from 1700 women with a mean age of 30.2 years (± 6.3) were analyzed. The most common MCDs were dysmenorrhea (43.8%) and mastodynia/mastalgia (21.1%). Three-month treatment with VAC extract substantially decreased the percentage of patients with irregular cycle (from 9.1% to 0.1%) and breast tenderness (from 39.9% to 0.8%). Improvement in bleeding intensity, frequency and menstrual pain was experienced by 83.4%, 79.2%, and 85.2% of the patients, respectively. When analyzed by disease category, these parameters improved in almost all dysmenorrhea patients, while they improved to a lesser extent in mastodynia/mastalgia patients. QoL improved in all aspects, but was reported by a higher proportion of dysmenorrhea patients compared to mastodynia/mastalgia patients. Treatment was overall well tolerated with a favorable safety profile. CONCLUSION These real-world data demonstrate the effectiveness of the VAC-containing products Cyclodynon® and Mastodynon® in the three-month treatment of MCDs, with a pronounced improvement in key disease symptoms and QoL. Intriguingly, while QoL was generally greatly improved, the response to VAC therapy varied depending on the type of underlying MCD.
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Affiliation(s)
- Martina Höller
- Bionorica SE, Kerschensteinerstr. 11-15, 92318, Neumarkt, Germany
| | - Hubert Steindl
- Bionorica SE, Kerschensteinerstr. 11-15, 92318, Neumarkt, Germany
| | | | - Julia Kleemann
- Bionorica SE, Kerschensteinerstr. 11-15, 92318, Neumarkt, Germany
| | - Alexey Loleit
- Amstelveenseweg 122A2, 1075 XL, Amsterdam, The Netherlands
| | - Christoph Abels
- Bionorica SE, Kerschensteinerstr. 11-15, 92318, Neumarkt, Germany
| | - Petra Stute
- Department of Obstetrics and Gynecology, Inselspital Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland.
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Roy S, Singh GN, Verma N, Parasher G, Suryavanshi P. Psychological Assessment and Treatment Effectiveness in Mastalgia: Developing a Treatment Algorithm. Cureus 2023; 15:e46838. [PMID: 38021953 PMCID: PMC10643197 DOI: 10.7759/cureus.46838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Mastalgia often impairs the physical, social, and sexual lives of women. It may manifest in both cyclical or acyclical patterns. The psychoneurotic association of mastalgia has been claimed for a long time in various available literature. Several treatment options have been used and are available in the market for mastalgia, but no specific guidelines are currently in place at the global or local levels. This study aims to evaluate the psychological status and effectiveness of various treatment options in women presenting with mastalgia. Methods This study was conducted in the General Surgery outpatient department from February 1 to November 30, 2021, at King George's Medical University, Lucknow, India. Females of all age groups presenting to the General Surgery outpatient department with unilateral/bilateral breast pain and/or chest wall pain were considered for this study. Pregnant patients, those with a history of allergy to drugs, or those who were lost to follow-up were excluded from the study. The psychological status of patients was assessed using the Depression Anxiety and Stress Scale (DASS-42) scale. Pain assessment was performed using a visual analog scale (VAS). Patients were divided into five categories: (i) isolated chest wall pain, (ii) isolated breast pain, (iii) both chest wall and breast pain, (iv) pain with an associated lump(s), and (v) pain and tenderness isolated over the lump, and two groups: Group-A: VAS≤4, and Group-B: VAS>4. Group B patients in Category iv were randomized into two groups: topical non-steroidal anti-inflammatory drugs (NSAIDs) or evening primrose oil+vitamin E. The next line of treatment was tamoxifen 10mg followed by danazol 100mg followed by ormeloxifene 30mg. Results The mean age of 106 participants enrolled was 31.59±10.52 years. The mean scores, using the DASS-42 scale, for depression, anxiety, and stress were 7.31±8.53, 7.08±6.57, and 11.15±8.07, respectively. The depression, anxiety, and stress scores had no significant correlation with pain scores (p =0.84, 0.99, and 0.97 for depression, anxiety, and stress, respectively), or duration (p=0.69, 0.66, and 0.85 for depression, anxiety, and stress, respectively). Twenty-nine of 43 patients (67.44%) responded to topical NSAIDs as first-line treatment, and out of the remaining, 6.98% responded to evening primrose oil + vitamin E, 18.60% to tamoxifen, and 4.65% to danazol. Twenty-nine of 32 patients (90.63%) responded to evening primrose oil+vitamin E as first-line treatment, while 6.25% and 3.12% responded to tamoxifen and danazol, respectively. Conclusions Both topical NSAIDs and evening primrose oil + vitamin E were found effective first-line treatment options in the majority of patients. Hence, it is always advisable to start such patients on topical NSAIDs, or evening primrose oil + vitamin E, before switching over (if no resolution of pain is reported with these drugs) to higher and more severe treatment options. The duration or severity of pain did not correlate with the psychological condition of the patient.
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Affiliation(s)
- Shubhajeet Roy
- Faculty of Medical Sciences, King George's Medical University, Lucknow, IND
| | - Gitika N Singh
- General Surgery, King George's Medical University, Lucknow, IND
| | - Nikhil Verma
- Faculty of Medical Sciences, King George's Medical University, Lucknow, IND
| | - Gunjan Parasher
- Faculty of Medical Sciences, King George's Medical University, Lucknow, IND
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Osouli Tabrizi S, Meedya S, Ghassab-Abdollahia N, Ghorbani Z, Jahangiry L, Mirghafourvand M. The effect of the herbal medicine on severity of cyclic mastalgia: a systematic review and meta-analysis. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2022; 19:855-868. [PMID: 34107571 DOI: 10.1515/jcim-2020-0531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/13/2021] [Indexed: 06/12/2023]
Abstract
Cyclic mastalgia is one of the most prevalent problems in women of reproductive age and sometimes it is so severe that it influences their activities and requires treatment. The available drug treatments for mastalgia are not satisfactory and most patients have inclined towards complementary and alternative medicine including herbal medicines. Therefore, in order to evaluate the effectiveness and side effects of herbal medicines conducting systematic review studies and meta-analysis seems essential, thus this systematic review was conducted with the aim of determining the effect of herbal medicines on cyclic mastalgia and its probable side effects. The databases of Pubmed, Medline, Embase, ProQuest, Scopus, Web of science, Complementary Medicine Database, SID (Scientific information database), Magiran and Iranmedex were searched from 1997 to 2020 and limited only for English and Persian languages. The studies were appraised according to the Cochrane Collaboration's tool. Meta-analysis was conducted using RevMan software. Standardized mean difference (SMD) was calculated to assess an overall estimate of effectiveness for the continuous data. Odds ratio (OR) was calculated for dichotomous data. Thirty papers were included in the study. Meta-analysis of data demonstrated that herbal medicine was an effective method in reducing the severity of mastalgia compared to the placebo (SMD: -3.26, 95% CI: -5.05 to -1.46, p=0.00004). Subanalysis of data showed no difference between the effectiveness of herbal medicine on the severity of mastalgia compared to the pharmacologic treatment. This research demonstrated efficacy of herbal medicines in alleviating cyclic mastalgia. Therefore, these herbal medicines can be regarded as an alternative treatment for women suffering from cyclic mastalgia. However, due to the limited number of studies in relation to each specific herbal treatment, conducting further studies in this area is recommended.
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Affiliation(s)
- Shirin Osouli Tabrizi
- Department of Midwifery, Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical sciences, Tabriz, Iran
| | - Shahla Meedya
- South Asia Infant Feeding Research Network (SAIFRN), School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Nafiseh Ghassab-Abdollahia
- Department of Midwifery, Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical sciences, Tabriz, Iran
| | - Zahra Ghorbani
- Department of Midwifery, Students Research Committee, Faculty of Nursing and Midwifery, Tabriz University of Medical sciences, Tabriz, Iran
| | - Leila Jahangiry
- Department of Health Education and Health Promotion, Faculty of Health, Tabriz University of Medical sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Management of Mastalgia. Surg Clin North Am 2022; 102:929-946. [DOI: 10.1016/j.suc.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Pleasant V. Management of breast complaints and high-risk lesions. Best Pract Res Clin Obstet Gynaecol 2022; 83:46-59. [PMID: 35570155 DOI: 10.1016/j.bpobgyn.2022.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/02/2022]
Abstract
Benign breast disease including palpable breast mass, mastalgia, skin changes, and nipple discharge are common gynecologic symptoms. Practitioners should be well versed in the components of clinical breast care. Workup begins with taking a thorough medical and family history to assess risk and performing a clinical breast examination. Breast imaging is often indicated for further evaluation. A structured approach to the evaluation and management of these breast conditions is critical to distinguish benign disease from malignancy. High-risk breast lesions such as atypical hyperplasia and lobular carcinoma in situ are also frequently encountered, and while benign, they do increase the future risk of breast cancer and patients should be offered intensive surveillance and chemoprevention.
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Affiliation(s)
- Versha Pleasant
- University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
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Gao M, Zhang H, Wang C, Mou X, Zhu Q, Wang J, Gao D. Top 100 Cited Papers on Premenstrual Syndrome/Premenstrual Dysphoric Disorder: A Bibliometric Study. Front Psychiatry 2022; 13:936009. [PMID: 35911247 PMCID: PMC9329608 DOI: 10.3389/fpsyt.2022.936009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Premenstrual syndrome/premenstrual dysphoric disorder is a serious condition affecting women worldwide, causing clinically significant distress or interference. Therefore, solving these diseases has become the utmost concern worldwide, culminating in numerous studies. In this study, we performed bibliometric analysis on the 100 most cited papers with the aim of identifying research hot spots and trends in this field. METHODS We screened the Science Citation Index Expanded (SCIE) of Web of Science (WOS) to identify the top 100 cited studies on PMS/PMDD. Next, we analyzed relevant literature from various journals, countries/regions, institutions, authors, and keywords. Finally, we used VOSviewer and Citespace software to generate knowledge maps and identify hot spots and trends. RESULTS The top 100 highly cited studies were published in 55 journals, between 1999 and 2017, across 24 countries/regions around the world. Most articles were published in Obstetrics and Gynecology, whereas Psych neuroendocrinology had the largest average number of citations per paper. The United States had the highest number of publications, followed by England, Canada, and Sweden. The top three institutions that published the highly cited literature were the University of Pennsylvania, Yale University, and National Institute of Mental Health (NIMH). Obstetrics, Gynecology, Psychiatry, and Reproductive Biology were the main research directions, whereas the top 10 Co-occurrence of Keywords included double-blind, fluoxetine, efficacy, prevalence, epidemiology, phase sertraline treatment, depression, progesterone, placebo, and placebo-controlled trial. Results from cluster analysis indicated that more comprehensive epidemiology and steroid pathogenesis have gradually become the hot spots and trends. CONCLUSION These findings demonstrated that bibliometric analysis can intuitively and rapidly reveal the frontiers and hot spots of research in PMS/PMDD. Notably, epidemiology, steroid pathogenesis, GABAA receptor delta subunits, and double-blind placebo-controlled trials are potential areas of focus for future research.
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Affiliation(s)
- Mingzhou Gao
- Team of Research and Innovation Focusing on Emotional Diseases and Syndromes, Innovation Research Institute of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hao Zhang
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Changlin Wang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiangyu Mou
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qingjun Zhu
- Team of Research and Innovation Focusing on Emotional Diseases and Syndromes, Innovation Research Institute of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jieqiong Wang
- School of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dongmei Gao
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
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Ma W, Jin ZN, Wang X, Fu FM, Guo WH, Xu YY, Chen B, Jin F, Wang C, Yao F. Clinical practice guideline for diagnosis and treatment of hyperplasia of the mammary glands: Chinese Society of Breast Surgery (CSBrS) practice guideline 2021. Chin Med J (Engl) 2021; 134:1891-1893. [PMID: 34310393 PMCID: PMC8382474 DOI: 10.1097/cm9.0000000000001521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Wei Ma
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Zi-Ning Jin
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Xu Wang
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Fang-Meng Fu
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
| | - Wen-Hui Guo
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
| | - Ying-Ying Xu
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Bo Chen
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Feng Jin
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Chuan Wang
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, China
| | - Fan Yao
- Department of Breast Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China
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Abstract
Introduction: Premenstrual dysphoric disorder (PMDD) is a distressing disorder amongst women of reproductive age group with significant implication in the productivity and quality of life of women who suffer from it. It is generally neglected as it is mostly undifferentiated from premenstrual symptoms—milder presentation of the same spectrum of problem but of lesser intensity and impairment. Objective: Here, in this article, we aim to highlight various studies and the research done on PMDD in the context of Indian women. Method: Reviewing the last 40 years’ database including Medline (PUBMED), Cochrane Library, EMBASE, Trip, Psych INFO, CINAHL, the Allied and Complementary Medicine Database (AMED), and the British Nursing Index. Results: PMDD is a troublesome disorder, often underdiagnosed. A thorough history including menstrual and sexual history, conducting a thorough physical examination, assessing the comorbidities, and finally using a proper and structured treatment protocol for managing the condition are recommended. Sertraline is the most widely studied drug which is found to be effective in PMDD.
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Affiliation(s)
- Dahuja Malvika
- Shaikh-ul-Hind Maulana Mahmood Hasan Medical College, Saharanpur, Uttar Pradesh, India
| | - Agarwal Supriya
- Netaji Subhash Chandra Bose Subharti Medical College, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
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Abadi Bavil D, Dolatian M, Mahmoodi Z, Akbarzadeh Baghban A. A comparison of physical activity and nutrition in young women with and without primary dysmenorrhea. F1000Res 2018; 7:59. [PMID: 30228874 PMCID: PMC6117855 DOI: 10.12688/f1000research.12462.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 12/03/2022] Open
Abstract
Background: Dysmenorrhea is the most common gynecological disorder in young women and is seen in almost 50% of women. The present study was conducted to investigate the relationship between physical activity and nutrition with primary dysmenorrhea in students at Mazandaran University of Medical Sciences (Sari, Iran) in 2015. Methods: This comparative descriptive study was conducted on 250 students with and without primary dysmenorrhea. Data were collected using personal-demographic, nutrition and physical activity questionnaires. The output was then analyzed in SPSS-18 using independent t-test, Chi-square test and logistic regression analysis. Results: The results showed significant differences between the two groups in terms of nutrition and physical activity, as the mean score of nutrition was 57.91 in the group with dysmenorrhea and 61.68 in the group without, while the mean intensity of physical activity was 5518.75 metric in the group with dysmenorrhea and 4666.42 metric in the group without. Physical activity was calculated by MET scale (minutes/week). This index measured the amount of consumed energy at the time of activity relative to that consumed at resting time. Conclusions: A healthier and more favorable nutrition style and more regular physical activity reduces the severity of dysmenorrhea in girls. Therefore, educational measures are required to raise awareness among young women about the effects of proper nutrition and physical activity on the prevention and reduction of dysmenorrhea complications.
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Affiliation(s)
- Dina Abadi Bavil
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahrokh Dolatian
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohreh Mahmoodi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Basic Sciences, School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hafiz SP, Barnes NLP, Kirwan CC. Clinical management of idiopathic mastalgia: a systematic review. J Prim Health Care 2018; 10:312-323. [DOI: 10.1071/hc18026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTIONIdiopathic mastalgia (benign breast pain of unknown origin) is often poorly managed because of its subjective nature and unclear aetiology. Mastalgia is a reason for up to 50% of breast outpatient referrals. Existing systematic reviews discuss dated treatment options that provide limited symptomatic relief.
METHODSA systematic review was conducted for aetiology and treatment of idiopathic mastalgia in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance. Databases such as PubMed, MEDLINE, Cochrane Database and the Clinical Trial Registry were searched (February 2016).
RESULTSReassurance plus bra-fitting advice provides relief for most women. If symptoms persist, addition of topical non-steroidal anti-inflammatory drugs (NSAIDs) provides relief in 70–92% of women. There is some benefit in reducing dietary coffee and fat intake. Medical treatments have serious side-effects (often androgenic or menopausal) and should be considered only in cases resistant to simpler measures. Dopamine agonists are useful, but less effective than endocrine treatments such as Danazol or Tamoxifen. Of the Selective Oestrogen Receptor Modulator drugs, Ormeloxifene appears most effective, but is not licenced in the United Kingdom. Relaxation therapy, acupuncture and kinesiology may be useful but currently lack good evidence of effectiveness.
DISCUSSIONFirst-line management of breast pain should be explanation, reassurance and a bra-fitting advice. Subsequent drug therapy should be balanced against its side-effects; topical NSAIDs and Ormeloxifene show greatest benefit with least side-effects. Newer agents (Ormeloxifene) currently being used for mastalgia in India could be considered in the developed world.
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Reid RL, Soares CN. Premenstrual Dysphoric Disorder: Contemporary Diagnosis and Management. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:215-223. [PMID: 29132964 DOI: 10.1016/j.jogc.2017.05.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/04/2017] [Indexed: 11/17/2022]
Abstract
Most ovulatory women experience premenstrual symptoms (premenstrual syndrome, molimina) which indicate impending menstruation and are of little clinical relevance because they do not affect quality of life. A few women, however, experience significant physical and/or psychological symptoms before menstruation that, if left untreated, would result in deterioration in functioning and relationships. The precise etiology remains elusive, although new theories are gaining support in pre-clinical and early clinical trials. Refined diagnostic criteria allow better discrimination of this condition from other psychiatric diagnoses and the selection of symptom appropriate therapies that afford relief for most women. Pharmacotherapies (particularly selective serotonin reuptake inhibitors and SNRIs) represent the first-line treatment for premenstrual dysphoric disorder and severe, mood-related premenstrual syndrome. Continuous combined oral contraceptives have limited evidence for usefulness in premenstrual dysphoric disorder, whereas medical ovarian suppression is often recommended for patients who fail to respond or cannot tolerate first-line treatments (e.g., selective serotonin reuptake inhibitors). The use of cognitive behavioural therapies is promising, but it remains limited by sparse data and restricted access to trained professionals. A proper diagnosis (particularly the distinction from other underlying psychiatric conditions) is crucial for the implementation of effective therapy and alleviation of this impairing condition.
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Affiliation(s)
- Robert L Reid
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Queen's University School of Medicine, Kingston, ON.
| | - Claudio N Soares
- Department of Psychiatry, Queen's University School of Medicine, Kingston, ON
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13
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Crow EM, Jeannot E. Premenstrual Syndrome: Symptomatic and Diagnosed Prevalence, Dualistic Treatment Approach - A Cross-Sectional Study in Ukraine. Int J Prev Med 2017; 8:66. [PMID: 28966755 PMCID: PMC5609352 DOI: 10.4103/ijpvm.ijpvm_18_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 06/23/2017] [Indexed: 11/17/2022] Open
Abstract
Background: Diagnosing and treatment of premenstrual syndrome (PMS) still pose a challenge in the routine medical practice which usually focuses on single pharmacological therapy. Recent research suggests that the combination of treatments including complementary alternative medicine (CAM) therapies may be more beneficial. The objective of this study was to assess the percentage of diagnosed and nondiagnosed PMS/premenstrual dysphoric disorder (PMDD) based on the presence of adequate symptoms and to compare population using hormonal or pharmaceutical agents versus CAM therapies. Methods: This is a cross-sectional study targeting sample population of 160 females of potentially reproductive age done in Ukraine between May 2014 and April 2015. Results: According to declared symptoms, 29% females versus 26% previously diagnosed by a medical professional qualify for “moderate/severe PMS,” P > 0.05. In 30% persons using pharmacological agents, major side effects, namely, nausea, insomnia, headache was caused by painkillers, contraceptives, and antidepressants. Only 37.5% of study population has been using CAM therapy methods to deal with the symptoms of PMS. Of these, 22% have achieved moderate degree in relief of the symptoms long term. Conclusions: We have concluded that when dealing with the burden of PMS/PMDD, the affected treatment-seeking women should have choice and access to the variety of therapies within integrative medicine (both conventional and nonconventional).
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Affiliation(s)
- Edith Meszaros Crow
- Researcher, University of Geneva, Faculty of Medicine, Institute of Global Health, Geneva, Switzerland
| | - Emilien Jeannot
- Researcher, University of Geneva, Faculty of Medicine, Institute of Global Health, Geneva, Switzerland.,University of Applied Sciences Western Switzerland, Haute Ecole de Santé, Delémont, Switzerland
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Abstract
Benign breast disease is a spectrum of common disorders. The majority of patients with a clinical breast lesion will have benign process. Management involves symptom control when present, pathologic-based and imaging-based evaluation to distinguish from a malignant process, and counseling for patients that have an increased breast cancer risk due to the benign disorder.
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16
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Pasta V, Dinicola S, Giuliani A, Harrath AH, Alwasel SH, Tartaglia F, Cucina A, Bizzarri M. A Randomized Pilot Study of Inositol in Association with Betaine and Boswellia in the Management of Mastalgia and Benign Breast Lump in Premenopausal Women. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2016; 10:37-43. [PMID: 27127407 PMCID: PMC4839963 DOI: 10.4137/bcbcr.s38408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/18/2016] [Accepted: 02/21/2016] [Indexed: 11/30/2022]
Abstract
Benign mammary lumps and mastalgia are the most common breast disorders; yet, there is no clear-cut consensus about the best strategy for their treatment. We hypothesized that a combination, including boswellic acid, betaine, and myoinositol, would be beneficial in breast disorders by exerting a pleiotropic effect on multiple pathways. Indeed, myoinositol has already been proven to modulate some factors involved in the genesis of breast diseases, such as fibrosis and metabolic and endocrine cues. In our study, 76 women were randomly assigned to either the experimental or the placebo arm. After six months of treatment, statistically significant differences between the two groups were recorded for pain relief (56% vs 17%) and breast density reduction (60% vs 9%). Furthermore, benign breast mass dimension showed a reduction in the experimental group (40% vs 16%). The combination of boswellic acid, betaine, and myoinositol has been demonstrated to be effective in the treatment of breast pain and radiologically and histologically confirmed benign breast mass and in the reduction of breast density, one of the pivotal risk factors for the development of breast cancer, without any side effects.
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Affiliation(s)
- Vittorio Pasta
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.; Azienda Policlinico Umberto I, Rome, Italy
| | - Simona Dinicola
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.; Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Alessandro Giuliani
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Abdel Halim Harrath
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Saleh H Alwasel
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Francesco Tartaglia
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.; Azienda Policlinico Umberto I, Rome, Italy
| | - Alessandra Cucina
- Azienda Policlinico Umberto I, Rome, Italy.; Department of Surgery "Pietro Valdoni", Sapienza University of Rome, Rome, Italy
| | - Mariano Bizzarri
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.; Systems Biology Group Lab, Sapienza University of Rome, Rome, Italy
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Bavil DA, Dolatian M, Mahmoodi Z, Baghban AA. Comparison of lifestyles of young women with and without primary dysmenorrhea. Electron Physician 2016; 8:2107-14. [PMID: 27123219 PMCID: PMC4844476 DOI: 10.19082/2107] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 02/06/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction Dysmenorrhea is one of the most common gynecologic disorders that affects women’s quality of life and social activities. Lifestyle, eating behaviors, and general health are essential to the management of menstrual symptoms. This study was conducted to examine the relationship between lifestyle and primary dysmenorrhea in students at Sari University of Medical Sciences in 2015 in order to facilitate the performance of lifestyle-improving interventions among young women. Methods This study was conducted on 250 students with and without primary dysmenorrhea at Sari University of Medical Sciences in 2015. Data were collected using personal-social and lifestyle questionnaires (addressing nutrition, physical activity, stress, social relationships, improper health behaviors, and self-care). The data were analyzed by SPSS software, version 18, using the independent-samples t-test, the chi-squared test, and logistic regression analysis. Results Given the scores obtained on the lifestyle questionnaire, significant differences were observed between the groups with and without dysmenorrhea in terms of eating behavior (p=0.008), physical activity (p=0.011), stress (p=0.041), and social relationships (p=0.000). No differences were observed in terms of self-care (p=0.115) and smoking, drinking, and drug use (p=0.355). According to the logistic regression analysis, age (OR=1.208, p=0.014), physical activity (OR=1.008, p=0.040) and social relationship (OR=0.952, p=0.002) were different in the two groups, but there was no statistical differences in their eating behavior, self-care, and stress. Conclusion To prevent and reduce the incidence of primary dysmenorrhea, knowledge and awareness should be raised in young women through proper lifestyle education and health promotion measures.
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Affiliation(s)
- Dina Abadi Bavil
- Department of Midwifery, International Branch, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahrokh Dolatian
- Assistant Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohreh Mahmoodi
- Assistant Professor of Social Determinant of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran; Assistant Professor of Nursing & Midwifery faculty, Alborz University of Medical Sciences, Karaj, Iran
| | - Alireza Akbarzadeh Baghban
- Ph.D in Biostatistics, Associate Professor, Proteomics Research Center, Department of Basic Sciences, School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Shobeiri F, Oshvandi K, Nazari M. Clinical effectiveness of vitamin E and vitamin B6 for improving pain severity in cyclic mastalgia. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2016; 20:723-7. [PMID: 26793260 PMCID: PMC4700694 DOI: 10.4103/1735-9066.170003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Recent attempts have been focused on employing chemical and natural supplemental agents for treatment of cyclic mastalgia. Among various agents, the potential effects of vitamins remain questionable. In the present study, we examined the efficacy of two types of these vitamin supplements (vitamin E and vitamin B6) in improving pain severity in cyclic mastalgia. Materials and Methods: In a randomized double-blinded clinical trial, 80 patients suffering from cyclic mastalgia were randomly assigned to receive 200 IU of vitamin E daily or 40 mg/day of vitamin B6 for 2 months. Written informed consent was obtained from all participants. Severity of breast pain was detected by the Cardiff breast pain score during one menstrual cycle before and two menstrual cycles after the intervention. Data were analyzed using t-test, Chi-squared test, analysis of variance (ANOVA), and regression with SPSS version 19 and P < 0.05 was considered significant. Results: There was no significant difference in the mean of severity of cyclic mastalgia during one menstrual cycle before the intervention between the vitamin E and B6 groups (9.1 ± 2.1 and 8.4 ± 3.1, respectively), but the difference was significant during the first cycle (5.1 ± 1.6 and 5.2 ± 2.5, respectively) and the second menstrual cycle (2.3 ± 1.0 and 2.6 ± 2.0, respectively) in the two groups after the intervention. The trend of changes in pain severity score showed significant downward trend of pain severity score within the study period in both the treatment groups (P < 0.001), while these trends were similar in both groups when examined by the repeated-measure ANOVA test. By multivariable linear regression analysis adjusted for baseline variables, we found that both the treatment regimens resulted in similar reduction in breast pain severity (P = 0.067). Conclusions: Both regimens containing vitamin E and vitamin B6 are similar in reducing breast pain severity in cyclic mastalgia.
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Affiliation(s)
- Fatemeh Shobeiri
- Department of Obstetrics, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Khodayar Oshvandi
- Department of Nursing, Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mansour Nazari
- Department of Medical Entomology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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A Comprehensive Review of Treatment Options for Premenstrual Syndrome and Premenstrual Dysphoric Disorder. J Psychiatr Pract 2015; 21:334-50. [PMID: 26352222 DOI: 10.1097/pra.0000000000000099] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome that involves a combination of emotional and physical symptoms that result in significant functional impairment. Because of the debilitating nature of PMDD, multiple treatment options have been considered. This review provides a comprehensive overview of these therapeutic regimens to help health care professionals provide adequate treatment for PMDD and premenstrual syndrome. The treatments that are reviewed are organized into the following categories: psychiatric, anovulatory, supplements, herbal, nonpharmacological, and other. Selective serotonin reuptake inhibitors have been established as the first-line treatment for PMDD. Although luteal phase or continuous dosing can be used, additional research is needed to more thoroughly compare the efficacies and differential symptom response of continuous, semi-intermittent, luteal phase, and symptoms-onset dosing. The psychiatric medications venlafaxine, duloxetine, alprazolam, and buspirone have also been found to be useful treatments for PMDD. Various anovulatory-related treatments have demonstrated efficacy; however, the use of some of these treatments remains limited due to potential side effects and/or the availability of cheaper alternatives. Although a variety of supplement and herbal-related treatments have been proposed, with some warranting further research, at this time only calcium supplementation has demonstrated a consistent therapeutic benefit. In conclusion, serotoninergic antidepressants have been established as the first-line treatment option for PMDD; however, there are a variety of additional treatment options that should be considered if a patient fails to achieve an adequate therapeutic response with a selective serotonin reuptake inhibitor.
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Waddell G, Pelletier J, Desindes S, Anku-Bertholet C, Blouin S, Thibodeau D. Effect of endometrial ablation on premenstrual symptoms. J Minim Invasive Gynecol 2015; 22:631-6. [PMID: 25643640 DOI: 10.1016/j.jmig.2015.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/19/2014] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To evaluate the effect of endometrial ablation on 6 premenstrual symptoms for up to 1 year after treatment. DESIGN Prospective cohort of 59 women awaiting endometrial ablation (Canadian Task Force classification II-2). SETTING University tertiary care hospital. PATIENTS Adult women of childbearing age awaiting endometrial ablation for heavy menstrual bleeding were recruited through the gynecology clinic of the Centre Hospitalier Universitaire de Sherbrooke. Fifty-nine patients were recruited, of whom 9 were excluded. Women were eligible to participate after an initial self-evaluation of ≥ 3 out of 10 for at least 1 premenstrual symptom. INTERVENTIONS Women underwent endometrial ablation using the microwave, impedance-controlled, or rollerball technique. MEASUREMENTS AND MAIN RESULTS Women had to fill out 2 surveys at 3 time points: before surgery, 4 months after surgery, and 12 months after surgery. The first survey consisted of visual analog scales for self-evaluation of 6 premenstrual symptoms (i.e., irritability, agitation/anxiety, depression/sadness, headache, swelling/bloating, and breast tenderness), and the second evaluated the heaviness of menstrual bleeding. The severity of all 6 symptoms decreased significantly (p < .025) up to 1 year after endometrial ablation. The greatest improvement was seen in swelling/bloating, with mean decreases of 4.1 on a scale of 10 at the 4-month follow-up and 3.1 at the 12-month follow-up. Women who reported the most severe symptoms before surgery appeared to have greater improvement compared with women with milder symptoms. Significant improvements were nevertheless observed in the mild severity subgroup for 4 of the 6 symptoms studied (i.e., irritability, depression, swelling/bloating, and breast tenderness). CONCLUSION Women reported significant improvement for the 6 premenstrual symptoms for up to 1 year following an endometrial ablation for heavy menstrual bleeding. The improvement of these symptoms appears to be linked to the efficacy of the procedure.
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Affiliation(s)
- Guy Waddell
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Sherbrooke, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.
| | - Joannie Pelletier
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Sherbrooke, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Sophie Desindes
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Sherbrooke, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Catherine Anku-Bertholet
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Sherbrooke, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Simon Blouin
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Sherbrooke, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Daniel Thibodeau
- Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Sherbrooke, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
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Abstract
Premenstrual dysphoric disorder (PMDD) is comprised of a cluster of affective, behavioral and somatic symptoms recurring monthly during the luteal phase of the menstrual cycle. The disorder affects 3-8% of menstruating women and represents the more severe and disabling end of the spectrum of premenstrual disorders, which includes premenstrual syndrome and premenstrual aggravation of underlying affective disorder. Rigorous and specific diagnostic criteria for PMDD were specified in the Diagnostic and Statistical Manual of Mental Disorders IV (1994) and reaffirmed in the Diagnostic and Statistical Manual of Mental Disorders V (2013) and, consequently, there has been a marked increase in well-designed, placebo-controlled studies evaluating treatment modalities. Although the exact pathogenesis of PMDD is still elusive, treatment of PMDD and severe premenstrual syndrome has centered on neuromodulation via serotonin reuptake inhibitor antidepressants, and ovulation suppression utilizing various contraceptive and hormonal preparations. Unlike the approach to the treatment of depression, serotonergic antidepressants need not be given daily, but can be effective when used cyclically, only in the luteal phase or even limited to the duration of the monthly symptoms. Less, well-substantiated alternative treatments, such as calcium supplementation, agnus castus (chasteberry), Hypericum perforatum (St John's wort) and cognitive/behavioral/relaxation therapies, may be useful adjuncts in the treatment of PMDD. This review provides an overview of current information on the treatment of PMDD.
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Affiliation(s)
- Andrea J Rapkin
- Department of Obstetrics & Gynecology, David Geffen School of Medicine at UCLA, University of California Los Angeles, 10833 Le Conte Avenue, Room 27-139 CHS, Los Angeles, CA 90095-1740, USA
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ISPMD consensus on the management of premenstrual disorders. Arch Womens Ment Health 2013; 16:279-91. [PMID: 23624686 PMCID: PMC3955202 DOI: 10.1007/s00737-013-0346-y] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 03/22/2013] [Indexed: 10/26/2022]
Abstract
The second consensus meeting of the International Society for Premenstrual Disorders (ISPMD) took place in London during March 2011. The primary goal was to evaluate the published evidence and consider the expert opinions of the ISPMD members to reach a consensus on advice for the management of premenstrual disorders. Gynaecologists, psychiatrists, psychologists and pharmacologists each formally presented the evidence within their area of expertise; this was followed by an in-depth discussion leading to consensus recommendations. This article provides a comprehensive review of the outcomes from the meeting. The group discussed and agreed that careful diagnosis based on the recommendations and classification derived from the first ISPMD consensus conference is essential and should underlie the appropriate management strategy. Options for the management of premenstrual disorders fall under two broad categories, (a) those influencing central nervous activity, particularly the modulation of the neurotransmitter serotonin and (b) those that suppress ovulation. Psychotropic medication, such as selective serotonin reuptake inhibitors, probably acts by dampening the influence of sex steroids on the brain. Oral contraceptives, gonadotropin-releasing hormone agonists, danazol and estradiol all most likely function by ovulation suppression. The role of oophorectomy was also considered in this respect. Alternative therapies are also addressed, with, e.g. cognitive behavioural therapy, calcium supplements and Vitex agnus castus warranting further exploration.
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Abstract
Several treatment strategies have been proposed for the management of depression in women. The occurrence of depression among females is often associated with periods of intense hormonal fluctuations, as observed in cases of premenstrual dysphoria, perinatal depression and with the development of depressive symptoms during the perimenopause. Various hormones including estrogen, progesterone, testosterone, dehydroepiandrosterone and thyroid hormones may exert modulatory effects on neurotransmitter pathways in the CNS. It has been postulated that abrupt changes in these hormones may negatively affect mood; conversely, hormonal interventions could potentially improve such symptoms. This article reviews the current literature on the impact of hormonal treatments for mood symptoms in women and preventative strategies for depression in women during the reproductive lifecycle.
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Affiliation(s)
- Claudio N Soares
- Women's Health Concerns Clinic, Department of Psychiatry and Behaviour Neurosciences, McMaster University, Canada.
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24
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Abstract
There is a well-established relationship between alterations of various hormonal systems and psychiatric disorders, both in endocrine and psychiatric patients. This has led to clinical and research studies examining the efficacy of the different hormones for treatment of depression. These data will be reviewed with particular regard to the thyroid, gonadal, pineal, and adrenal cortex hormones. The data generally provide limited, but varying evidence for the antidepressant efficacy of these hormones.
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Affiliation(s)
- Russell T Joffe
- LIJ North Shore Staten Island University Hospital, New York 10305, USA.
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25
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Abstract
As many as 7% of women experience significant social or occupational dysfunction as a result of severe premenstrual mood disturbance. Biological, psychological, and sociocultural factors are implicated in the cause of premenstrual dysphoric disorder, but the interaction between these factors remains to be elucidated. Mental health practitioners can aid women by providing diagnostic clarity and by initiating an integrated step-wise management approach.
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26
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Abstract
The biological plausibility for the effect of sex hormones on the central nervous system is now supported by a considerable amount of clinical data. This critical review guides the reader through the plethora of data, from the earliest reports of menstrual madness in the nineteenth century to neurobiological work in the new millennium. It illustrates through the scientific evidence base that, although the effect of estrogen on the central nervous system, particularly on mood and depression, remains a controversial area, there is now considerable evidence for the psychotherapeutic benefits of estrogens in the triad of hormone-responsive depressive disorders: postnatal depression, premenstrual depression and perimenopausal depression. The article also reviews the compelling data that testosterone supplementation has positive effects for depression, libido and energy, particularly where patients have only partially responded to estrogen therapy.
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Affiliation(s)
- J Studd
- Chelsea & Westminster Hospital, London, UK
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27
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Vigod SN, Ross LE, Steiner M. Understanding and treating premenstrual dysphoric disorder: an update for the women's health practitioner. Obstet Gynecol Clin North Am 2009; 36:907-24, xii. [PMID: 19944308 DOI: 10.1016/j.ogc.2009.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Up to 7% of women report premenstrual symptoms severe enough to impair daily function, and are said to suffer from premenstrual dysphoric disorder (PMDD). Although PMDD is predominately regarded as a biologically based condition, sociocultural factors, and particularly life stress, past sexual abuse, and cultural socialization, likely interact with hormonal changes. This integrative model has implications for etiology and treatment of PMDD.
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Affiliation(s)
- Simone N Vigod
- Department of Psychiatry Women's College Hospital, Room 944C, Ontario, Canada
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28
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Abstract
This study investigated the effects of Qi-therapy (nine sessions over two menstrual cycles) on pain and other symptoms in women with premenstrual syndrome (PMS). Forty-six women who were attending college were randomly allocated to receive Qi-therapy (Qi-therapy group: n = 23) or placed on a waiting list as controls (n = 22: 1 dropped out). Qi-therapy had a significant effect on pain and water retention. In addition, there were significant short-term effects on pain, mental depression, and anxiety. These results suggested that Qi-therapy might be useful as a nursing intervention for women who suffer from PMS to maintain or restore a balance of Qi.
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Affiliation(s)
- Hye-Sook Jang
- Department of Nursing, Wonkwang Health Science College, Iksan, Korea
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29
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Abstract
Breast concerns commonly occur in the outpatient setting and predominantly consist of breast pain, nipple discharge, and breast masses. Many of these concerns can be treated with reassurance and reevaluation, but not if the patient has risk factors for an underlying pathology. This article reviews the diagnosis and treatment of the three most common breast concerns encountered in primary care practices.
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Affiliation(s)
- Ann M Rodden
- Department of Family Medicine, Medical University of South Carolina, 295 Calhoun Street, Charleston, SC 29425, USA.
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30
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Studd J, Panay N. Are oestrogens useful for the treatment of depression in women? Best Pract Res Clin Obstet Gynaecol 2009; 23:63-71. [DOI: 10.1016/j.bpobgyn.2008.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cunningham J, Yonkers KA, O'Brien S, Eriksson E. Update on research and treatment of premenstrual dysphoric disorder. Harv Rev Psychiatry 2009; 17:120-37. [PMID: 19373620 PMCID: PMC3098121 DOI: 10.1080/10673220902891836] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Many women in their reproductive years experience some mood, behavioral. or physical symptoms in the week prior to menses. Variability exists in the level of symptom burden in that some women experience mild symptoms, whereas a small minority experience severe and debilitating symptoms. For an estimated 5%-8% of premenopausal women, work or social functioning are affected by severe premenstrual syndrome. Many women in this group meet diagnostic criteria for premenstrual dysphoric disorder (PMDD). Among women who suffer from PMDD, mood and behavioral symptoms such as irritability, depressed mood, tension, and labile mood dominate. Somatic complaints, including breast tenderness and bloating, also can prove disruptive to women's overall functioning and quality of life. Recent evidence suggests that individual sensitivity to cyclical variations in levels of gonadal hormones may predispose certain women to experience these mood, behavioral, and somatic symptoms. Treatments include: antidepressants of the serotonin reuptake inhibitor class, taken intermittently or throughout the menstrual cycle; medications that suppress ovarian cyclicity; and newer oral contraceptives with novel progestins.
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Affiliation(s)
- Joanne Cunningham
- Department of Psychiatry, Yale University, New Haven, CT 06510, USA.
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Jarvis CI, Lynch AM, Morin AK. Management Strategies for Premenstrual Syndrome/Premenstrual Dysphoric Disorder. Ann Pharmacother 2008; 42:967-78. [DOI: 10.1345/aph.1k673] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To evaluate the current nonpharmacologic and pharmacologic treatment options for symptoms of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Data Sources: Literature was obtained through searches of MEDLINE Ovid (1950–March week 3, 2008) and EMBASE Drugs and Pharmacology (all years), as well as a bibliographic review of articles identified by the searches. Key terms included premenstrual syndrome, premenstrual dysphoric disorder, PMS, PMDD, and treatment. Study Selection/Data Extraction: All pertinent clinical trials, retrospective studies, and case reports in human subjects published in the English language were identified and evaluated for the safety and efficacy of pharmacologic and nonpharmacologic treatments of PMS/PMDD. Data from these studies and information from review articles were included in this review. Data Synthesis: Selective serotonin-reuptake inhibitors (SSRIs) have been proven safe and effective for the treatment of PMDD and are recommended as first-line agents when pharmacotherapy is warranted. Currently fluoxetine, controlled-release paroxetine, and sertraline are the only Food and Drug Administration-approved agents (or this indication. Suppression of ovulation using hormonal therapies is an alternative approach to treating PMDD when SSRIs or second-line psychotropic agents are ineffective; however, adverse effects limit their use. Anxiolytics, spironolactone, and nonsteroidal antiinflammatory drugs can be used as supportive care to relieve symptoms. Despite lack of specific evidence, lifestyle modifications and exercise are first-line recommendations for all women with PMS/PMDD and may be all that is needed to treat mild-to-moderate symptoms. Herbal and vitamin supplementation and complementary and alternative medicine have been evaluated for use in PMS/PMDD and have produced unclear or conflicting results. More controlled clinical trials are needed to determine their safety and efficacy and potential for drug interactions. Conclusions: Healthcare providers need to be aware of the symptoms of PMS and PMDD and the treatment options available. Treatment selection should be based on Individual patient symptoms, concomitant medical history, and need for contraception.
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Affiliation(s)
- Courtney I Jarvis
- Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences-Worcester/Manchester, Worcester, MA
| | - Ann M Lynch
- Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences-Worcester/Manchester
| | - Anna K Morin
- Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences-Worcester/Manchester
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Abstract
Most women of reproductive age have some physical discomfort or dysphoria in the weeks before menstruation. Symptoms are often mild, but can be severe enough to substantially affect daily activities. About 5-8% of women thus suffer from severe premenstrual syndrome (PMS); most of these women also meet criteria for premenstrual dysphoric disorder (PMDD). Mood and behavioural symptoms, including irritability, tension, depressed mood, tearfulness, and mood swings, are the most distressing, but somatic complaints, such as breast tenderness and bloating, can also be problematic. We outline theories for the underlying causes of severe PMS, and describe two main methods of treating it: one targeting the hypothalamus-pituitary-ovary axis, and the other targeting brain serotonergic synapses. Fluctuations in gonadal hormone levels trigger the symptoms, and thus interventions that abolish ovarian cyclicity, including long-acting analogues of gonadotropin-releasing hormone (GnRH) or oestradiol (administered as patches or implants), effectively reduce the symptoms, as can some oral contraceptives. The effectiveness of serotonin reuptake inhibitors, taken throughout the cycle or during luteal phases only, is also well established.
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Usman SB, Indusekhar R, O'Brien S. Hormonal management of premenstrual syndrome. Best Pract Res Clin Obstet Gynaecol 2008; 22:251-60. [PMID: 17761457 DOI: 10.1016/j.bpobgyn.2007.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Premenstrual syndrome (PMS) is a psychological and somatic disorder of unknown aetiology. The symptoms of PMS regularly occur during the luteal phase of the menstrual cycle and resolve by the end of menstruation. The severe and predominantly psychological form of PMS is called 'premenstrual dysphoric disorder'. PMS results from ovulation and appears to be caused by the progesterone produced following ovulation in women who have enhanced progesterone sensitivity. This enhanced sensitivity may be due to neurotransmitter dysfunction. Treatment is aimed at suppressing ovulation or reducing progesterone sensitivity. This chapter will describe the role of hormones and hormonal treatments in PMS.
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Affiliation(s)
- Sa'adatu Bose Usman
- Department of Obstetrics and Gynaecology, University Hospital of North Staffordshire, Stoke on Trent ST4 6QG, UK.
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36
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Hussain Z, Brooks J, Percy D. Menstrual variation of breast volume and T2 relaxation times in cyclical mastalgia. Radiography (Lond) 2008. [DOI: 10.1016/j.radi.2006.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Srivastava A, Mansel RE, Arvind N, Prasad K, Dhar A, Chabra A. Evidence-based management of Mastalgia: A meta-analysis of randomised trials. Breast 2007; 16:503-12. [PMID: 17509880 DOI: 10.1016/j.breast.2007.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Accepted: 03/19/2007] [Indexed: 10/23/2022] Open
Abstract
Several agents have been utilised for therapy of mastalgia based on data from small trials. No meta-analysis of trials on mastalgia exists. We have conducted a meta-analysis on trials on mastalgia published in the English language. Study was restricted to randomised controlled trials comparing Bromocriptine, Danazol, Evening primrose oil (EPO) and Tamoxifen with placebo. The analysis was carried out on the REVMAN statistical package. Weighted mean difference in the pain score in favour of Bromocriptine was -16.31(95% CI -26.35 to -6.27). Danazol produced a significant benefit with a mean pain score difference -20.23(95% CI -28.12 to -12.34). EPO did not offer any advantage over placebo in pain relief, mean pain score difference being -2.78 (95% CI -7.97 to 2.40). Tamoxifen achieved a relative risk (RR) of pain relief of 1.92 (95% CI 1.42-2.58). Tamoxifen is associated with least side effects and should be the drug of first choice.
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Affiliation(s)
- A Srivastava
- University Department of Surgery, Cardiff University, UK
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Indusekhar R, Usman SB, O'Brien S. Psychological aspects of premenstrual syndrome. Best Pract Res Clin Obstet Gynaecol 2007; 21:207-20. [PMID: 17175199 DOI: 10.1016/j.bpobgyn.2006.10.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Premenstrual syndrome (PMS) is a group of psychological and physical symptoms which regularly occur during the luteal phase of the menstrual cycle and resolve by the end of menstruation. The severe and predominantly psychological form of PMS is called premenstrual dysphoric disorder (PMDD). The exact aetiology of PMS is not known. PMS results from ovulation and appears to be caused by the progesterone produced following ovulation in women who have enhanced sensitivity to this progesterone. The increased sensitivity may be due to neurotransmitter (mainly serotonin) dysfunction. The key diagnostic feature is that the symptoms must be absent in the time between the end of menstruation and ovulation. Prospective symptom rating charts are used for this purpose. Treatment is achieved by suppression of ovulation or reducing progesterone sensitivity with selective serotonin re-uptake inhibitors. In this chapter, the authors describe the aetiology, symptoms, diagnosis and evidence-based management of premenstrual syndrome.
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Affiliation(s)
- Radha Indusekhar
- Academic Unit, University Hospital of North Staffordshire, Stoke-on-Trent ST4 6QG, UK.
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Oksa S, Luukkaala T, Mäenpää J. Toremifene for premenstrual mastalgia: a randomised, placebo-controlled crossover study. BJOG 2006; 113:713-8. [PMID: 16709215 DOI: 10.1111/j.1471-0528.2006.00943.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the efficacy of toremifene in the treatment of premenstrual mastalgia. DESIGN Double-blind, placebo-controlled crossover study. SETTING Three Finnish general practices from the districts of Satakunta Central Hospital and Tampere University Hospital. POPULATION A total of 62 women aged 25-45 years with premenstrual mastalgia during at least three previous menstrual cycles. METHODS Women were randomised to receive toremifene 20 mg daily or placebo from day 15 of the menstrual cycle until menstruation for three consecutive cycles. After a wash-out cycle, the women were crossed over to receive placebo or toremifene for three additional cycles. MAIN OUTCOME MEASURES Cyclic breast pain relief assessed by visual analogue scale (VAS) score. Quality-of-life scores assessed by a modified 36-item Finnish Depression Scale, with a score ranging from 0 to 108. Acceptability of treatment. RESULTS About 32 women were randomised to receive toremifene first and 30 to receive placebo first. Twenty-nine and 27 participants in the groups treated with toremifene first or placebo first completed the treatment, respectively. There were significant reductions in VAS scores in both groups after three treatment cycles. This was significantly greater in the toremifene-treated group (VAS: 1.8 in the toremifene group and 3.7 in the placebo group, P= 0.004). Treatment effect between treatment cycles was significant (P= 0.001). Quality of life was similar during the toremifene and placebo cycles. CONCLUSION This study demonstrates that the antiestrogenic compound, toremifene, is able to relieve premenstrual breast pain without major adverse effects. There was a 64% reduction in median pain scores in the toremifene-treated cycles compared with a 26% reduction in placebo-treated cycles.
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Affiliation(s)
- S Oksa
- Department of Obstetrics and Gynaecology, Satakunta Central Hospital, Pori, Finland.
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41
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Abstract
This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.
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Affiliation(s)
- Richard J Santen
- Department of Medicine, University of Virginia Health Sciences Center, Charlottesville, VA, USA.
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Choi DS. Guidelines for Clinical Management of Premenstrual Syndrome. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2005. [DOI: 10.5124/jkma.2005.48.5.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Doo Seok Choi
- Department of Obstetrics & Gynecology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Korea.
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Johnson SR. Premenstrual Syndrome, Premenstrual Dysphoric Disorder, and Beyond: A Clinical Primer for Practitioners. Obstet Gynecol 2004; 104:845-59. [PMID: 15458909 DOI: 10.1097/01.aog.0000140686.66212.1e] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The management of adverse premenstrual symptoms has presented a difficult challenge for clinicians. However, based on numerous well-designed research studies over the last decade, we now have diagnostic criteria for the severe form of the syndrome, premenstrual dysphoric disorder, and a variety of evidence-based therapeutic strategies. This review presents a comprehensive, practical description of what the clinician needs to know to diagnose and treat adverse premenstrual symptoms at all levels of severity. Diagnostic criteria are described in detail, including a discussion of the distinction between premenstrual dysphoric disorder and premenstrual syndrome (PMS). The rationale for including prospective symptom calendars as a routine part of the diagnostic evaluation of severe symptoms is presented. The differential diagnosis of cyclic symptoms, including depression and anxiety disorders, menstrual migraine, and mastalgia, and an approach for the management of each of these problems are presented. A treatment approach is recommended that matches the treatment to the degree of problems the woman is experiencing. Serotonin reuptake inhibitors are the treatment of choice for severe symptoms, and most women with PMS/premenstrual dysphoric disorder will respond to intermittent, luteal phase-only therapy. Ovulation suppression should be reserved for women who do not respond to other forms of therapy. The role of oophorectomy is limited, and guidelines for its use are presented.
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Affiliation(s)
- Susan R Johnson
- Roy J. and Lucille A. Carver College of Medicine, 2130E Med labs, University of Iowa, Iowa City, IA 52242, USA. susan-johnson@uiowa,edu
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Jang HS, Lee MS. Effects of Qi Therapy (External Qigong ) on Premenstrual Syndrome: A Randomized Placebo-Controlled Study. J Altern Complement Med 2004; 10:456-62. [PMID: 15253849 DOI: 10.1089/1075553041323902] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the effects of qi therapy on premenstrual symptoms in women with premenstrual syndrome (PMS). DESIGN A randomized placebo-controlled trial. SUBJECTS Thirty-six (36) college women with symptoms of PMS. INTERVENTION After 2 months of screening, subjects with PMS were randomized to receive real qi therapy (18 subjects) or placebo (18 subjects). The subjects were informed that they would receive one of two types of treatment. They did not know which treatment they received. Each intervention was performed eight times during the second and third cycles with subjects completing a PMS diary. RESULTS There were significant improvements in the symptoms of negative feeling, pain, water retention, and total PMS symptoms in subjects receiving qi therapy compared to placebo controls. CONCLUSION Qi therapy may be an effective complementary therapy for managing the symptoms of PMS.
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Affiliation(s)
- Hye-Sook Jang
- Department of Nursing, Wonkwang Health Science College, Iksan, Korea
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Abstract
Pain is one of the most common breast symptoms experienced by women. It can be severe enough to interfere with usual daily activities, but the etiology and optimal treatment remain undefined. Breast pain is typically approached according to its classification as cyclic mastalgia, noncyclic mastalgia, and extramammary (nonbreast) pain. Cyclic mastalgia is breast pain that has a clear relationship to the menstrual cycle. Noncyclic mastalgia may be constant or intermittent but is not associated with the menstrual cycle and often occurs after menopause. Extramammary pain arises from the chest wall or other sources and is interpreted as having a cause within the breast. The risk of cancer in a woman presenting with breast pain as her only symptom is extremely low. After appropriate clinical evaluation, most patients with breast pain respond favorably to a combination of reassurance and nonpharmacological measures. The medications danazol, tamoxifen, and bromocriptine are effective; however, the potentially serious adverse effects of these medications limit their use to selected patients with severe, sustained breast pain. The status of other therapeutic strategies and directions for future research are discussed.
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Affiliation(s)
- Robin L Smith
- Breast Diagnostic Clinic, Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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Abstract
Though epidemiological data is difficult to collect, existing evidence indicates that there is a small but significant population of women in whom premenstrual symptoms, and particularly affective symptoms, severely impair functioning. Although PMDD is predominantly regarded as a biologically based illness, there is strong evidence that variables such as life stress, history of sexual abuse, and cultural socialization are important determinants of premenstrual symptoms. In diagnosing and treating PMDD patients, attention to biological and sociocultural variables is recommended.
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Affiliation(s)
- Lori E Ross
- Women's Health Concerns Clinic and Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, Fontbonne Building, 6th Floor, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada
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Abstract
Severe premenstrual syndrome (PMS) and, more recently, premenstrual dysphoric disorder (PMDD) have been studied extensively over the last 20 years. The defining criteria for diagnosis of the disorders according to the American College of Obstetricians and Gynecologists (ACOG) include at least one moderate to severe mood symptom and one physical symptom for the diagnosis of PMS and by DSM IV criteria a total of 5 symptoms with 1 severe mood symptom for the diagnosis of PMDD. There must be functional impairment attributed to the symptoms. The symptoms must be present for one to two weeks premenstrually with relief by day 4 of menses and should be documented prospectively for at least two cycles using a daily rating form. Nonpharmacologic management with some evidence for efficacy include cognitive behavioral relaxation therapy, aerobic exercise, as well as calcium, magnesium, vitamin B(6) L-tryptophan supplementation or a complex carbohydrate drink. Pharmacologic management with at least ten randomized controlled trials to support efficacy include selective serotonin reuptake inhibitors administered daily or premenstrually and serotonergic tricyclic antidepressants. Anxiolytics and potassium sparing diuretics have demonstrated mixed results in the literature. Hormonal therapy is geared towards producing anovulation. There is good clinical evidence for GnRH analogs with addback hormonal therapy, danocrine, and estradiol implants or patches with progestin to protect the endometrium. Oral contraceptive pills prevent ovulation and should be effective for the treatment of PMS/PMDD. However, limited evidence does not support efficacy for oral contraceptive agents containing progestins derived from 19-nortestosterone. The combination of the estrogen and progestin may produce symptoms similar to PMS, such as water retention and irritability. There is preliminary evidence that a new oral contraceptive pill containing low-dose estrogen and the progestin drospirenone, a spironolactone analog, instead of a 19-nortestosterone derivative can reduce symptoms of water retention and other side effects related to estrogen excess. The studies are in progress, however, preliminary evidence suggests that the drospirenone-containing pill called Yasmin may be effective the treatment of PMDD.
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Affiliation(s)
- Andrea Rapkin
- UCLA School of Medicine, Department of Obstetrics and Gynecology, Center for the Health Sciences, Los Angeles, CA 90095-1740, USA.
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Bäckström T, Andreen L, Birzniece V, Björn I, Johansson IM, Nordenstam-Haghjo M, Nyberg S, Sundström-Poromaa I, Wahlström G, Wang M, Zhu D. The role of hormones and hormonal treatments in premenstrual syndrome. CNS Drugs 2003; 17:325-42. [PMID: 12665391 DOI: 10.2165/00023210-200317050-00003] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Premenstrual syndrome (PMS) is a menstrual cycle-linked condition with both mental and physical symptoms. Most women of fertile age experience cyclical changes but consider them normal and not requiring treatment. Up to 30% of women feel a need for treatment. The aetiology is still unclear, but sex steroids produced by the corpus luteum of the ovary are thought to be symptom provoking, as the cyclicity disappears in anovulatory cycles when a corpus luteum is not formed. Progestogens and progesterone together with estrogen are able to induce similar symptoms as seen in PMS. Symptom severity is sensitive to the dosage of estrogen. The response systems within the brain known to be involved in PMS symptoms are the serotonin and GABA systems. Progesterone metabolites, especially allopregnanolone, are neuroactive, acting via the GABA system in the brain. Allopregnanolone has similar effects as benzodiazepines, barbiturates and alcohol; all these substances are known to induce adverse mood effects at low dosages in humans and animals. SSRIs and substances inhibiting ovulation, such as gonadotrophin-releasing hormone (GnRH) agonists, have proven to be effective treatments. To avoid adverse effects when high dosages of GnRH agonists are used, add-back hormone replacement therapy is recommended. Spironolactone also has a beneficial effect, although not as much as SSRIs and GnRH agonists.
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Affiliation(s)
- Torbjörn Bäckström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden.
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