Pre-menstrual Syndrome and Pre-menstrual Dysphoric Disorder in Female Medical Students of Nepal.

Background Pre-menstrual Syndrome and Pre-menstrual Dysphoric Disorder can have negative impact on medical students and remains mostly underdiagnosed. Different treatment modalities like medications (doctor-prescribed or self-medicated), and alternative therapies are used by students to cope with pre-menstrual symptoms. Objective To estimate the prevalence and severity of Premenstrual Syndrome and Premenstrual Dysphoric Disorder among medical students in Nepal along with its impact in their quality of life, their health seeking behavior and treatment modalities used to cope with these disorders. Method A cross-sectional study was conducted among female medical students studying MBBS in various medical colleges in Nepal using a self-administered questionnaire from September 2020 to March 2021. Result The prevalence of Premenstrual Syndrome and Premenstrual Dysphoric Disorder among female medical students in Nepal was 64% and 36.3% respectively as per this study. Among the areas impacted by premenstrual symptoms, concentration in class was the most affected (68.1%), followed by distress (64.6%). Only 7.3% of the responding participants sought medical consultation for their symptoms. Among those who suffered from at least one symptom for any length of time, 34.8% of participants reported of using at least one medication (either prescribed or selfmedication). Similarly, alternative remedies were used by 44.4% of the participants. Conclusion Premenstrual syndrome and premenstrual dysphoric disorder were found to be common in female medical students of Nepal. However, very few students sought medical consultation despite a significant impact in their academic and other activities. Self-medication and traditional therapies were common modalities used for treatment of premenstrual symptoms.

Associations of premenstrual symptoms with daily rumination and perceived stress and the moderating effects of mindfulness facets on symptom cyclicity in premenstrual syndrome.

Subthreshold premenstrual symptoms can be impairing even if the diagnostic criteria for premenstrual dysphoric disorder (PMDD) are not reached. Previous research suggests shared psychological risk factors without a clear differentiation of premenstrual syndrome (PMS) from PMDD. This study focuses on a sample with a wide range of premenstrual symptoms not reaching PMDD-criteria and aims to investigate within-person associations of premenstrual symptoms with daily rumination and perceived stress during the late luteal phase as well as cycle-phase specific associations of habitual mindfulness including present-moment-awareness and acceptance with premenstrual symptoms and impairment. Fifty-six naturally cycling women with self-reported premenstrual symptoms completed an online diary on premenstrual symptoms, rumination and perceived stress over two consecutive menstrual cycles, and baseline questionnaires on habitual present-moment-awareness and acceptance. Multilevel analyses revealed cycle-related variations in premenstrual symptoms and impairment (all ps < .001). Higher within-person levels of core and secondary premenstrual symptoms during the late luteal phase predicted increased daily rumination and perceived stress (all ps < .001) and increased somatic symptoms predicted increased rumination (p ≤ .018). Higher habitual present-moment-awareness was linked to lower premenstrual symptom and impairment levels toward the late luteal phase whereas higher habitual acceptance was associated with lower premenstrual functional impairment (p ≤ .015). Premenstrual symptom increases during the late luteal phase in women with PMS seem to be linked to increased daily rumination and perceived stress. Trait present-moment-awareness and acceptance in turn seem to reflect protective factors against premenstrual distress and may represent useful targets for interventions.

Evaluation of a Prognostic Homeopathic Questionnaire for Women with Premenstrual Disorders.

BACKGROUND/AIMS: Validation of treatments with individually prescribed homeopathic medicines is a challenging task. A prognostic homeopathic patient questionnaire containing 140 keynote symptoms (highly characteristic of a specific homeopathic medicine) and an electronic algorithm to process the answers were used in 2 clinical studies. The algorithm outcome, based on total symptom scores, indicated 1 of 11 pre-selected homeopathic medicines for women with premenstrual syndrome and premenstrual dysphoric disorder (PMS/PMDD). Aims were (1) to estimate the prognostic values of keynote symptoms and (2) to evaluate the reliability of the homeopathic medicine ranking in the algorithm outcome. METHODS: The prevalence of specific keynote symptoms was calculated in 145 women diagnosed with PMS/PMDD and in 40 included women with favorable outcomes using 1 of the 11 homeopathic medicines. Likelihood ratios (LRs) of the keynote symptoms were calculated. Pearson's correlations were calculated between 2 sets of total algorithm scores for 11 homeopathic medicines, obtained at 2 time points. RESULTS: (1) A positive prognostic value (LR ≥ 1.5) was found in 34 keynote symptoms with a prevalence of 10-40%, with 10 symptoms already being connected to the corresponding homeopathic medicine in the algorithm. For example, the symptom 'common cold of the nose before menstruation' indicated Magnesium carbonicum with LR = 7.47 (confidence interval (CI) 3.90-14.28). (2) Pearson's correlations for the reliability evaluation varied from 0.69 to 0.84. CONCLUSIONS: Recommendations can be made to improve the PMS algorithm with more accurate keynote symptoms. The prognostic questionnaire proved a reliable tool to rank 11 homeopathic medicines by total scores, based on keynote symptoms. This PMS algorithm can be used for the treatment of PMS/PMDD in clinical practice.

Premenstrual Syndrome: Evidence-based Evaluation and Treatment.

Premenstrual dysphoric disorder (PMDD) is defined by both physical and psychiatric symptoms that impact a woman significantly during the luteal phase of her menstrual cycle. Diagnostic criteria for PMDD were firmly established in the Diagnostic and Statistical Manual of Mental Disorders V in 2013, but many patients fall short of the diagnosis while still appreciably affected by severe premenstrual symptoms. More recent and robust investigations have evaluated the efficacy of treatment ranging from serotonergic therapy to hormonal treatment as well as lifestyle and herbal remedies. This article reviews the evidence for diagnosis and treatment of PMDD.

Premenstrual disorders.

Premenstrual disorders include premenstrual syndrome, premenstrual dysphoric disorder, and premenstrual worsening of another medical condition. While the underlying causes of these conditions continue to be explored, an aberrant response to hormonal fluctuations that occurs with the natural menstrual cycle and serotonin deficits have both been implicated. A careful medical history and daily symptom monitoring across 2 menstrual cycles is important in establishing a diagnosis. Many treatments have been evaluated for the management of premenstrual disorders. The most efficacious treatments for premenstrual syndrome and premenstrual dysphoric disorder include serotonin reuptake inhibitors and contraceptives with shortened to no hormone-free interval. Women who do not respond to these and other interventions may benefit from gonadotropin-releasing hormone agonist treatment.

Interdisciplinary consensus on management of premenstrual disorders in Switzerland.

Premenstrual disorders (PMD) can affect women throughout their entire reproductive years. In 2016, an interdisciplinary expert meeting of general gynecologists, gynecological endocrinologists, psychiatrists and psychologists from Switzerland was held to provide an interdisciplinary algorithm on PMD management taking reproductive stages into account. The Swiss PMD algorithm differentiates between primary and secondary PMD care providers incorporating different levels of diagnostic and treatment. Treatment options include cognitive behavioral therapy, alternative therapy, antidepressants, ovulation suppression and diuretics. Treatment choice depends on prevalent PMD symptoms, (reproductive) age, family planning, cardiovascular risk factors, comorbidities, comedication and the woman's preference. Regular follow-ups are mandatory.

Complementary and alternative therapies for premenstrual syndrome: an exploratory study

Background: Data related to the use of complementary and alternative therapies (CAT) for premenstrual syndrome in the communities is scarce. There is very limited information about complementary and alternative therapies practice among nursing students in Dakhalia governorate,Egypt.Methods: A descriptive exploratory design was conducted in Dakahlia governorate, Egypt, on all secondary technical nursing schools students to explore the use of complementary and alternative therapies to relieve premenstrual syndrome. A sample of 1120 students was included. A structured self-administered questionnaire (Arabic language) was used for data collection in the period of March to May, 2014. Results: Most of the study subjects (87.0%) used CAT to minimize symptoms of premenstrual syndrome. Herbal therapy was the most commonly used as CAT followed by hydrotherapy, changing food types, massage and exercise. Conclusion: The majority of girls used CAT to minimize PMS. The greater part of students used herbal therapy to relieve their symptoms, followed by hydrotherapy; food Change; massage; and exercise

Premenstrual Syndrome and Premenstrual Dysphoric Disorder.

Premenstrual disorders affect up to 12% of women. The subspecialties of psychiatry and gynecology have developed overlapping but distinct diagnoses that qualify as a premenstrual disorder; these include premenstrual syndrome and premenstrual dysphoric disorder. These conditions encompass psychological and physical symptoms that cause significant impairment during the luteal phase of the menstrual cycle, but resolve shortly after menstruation. Patientdirected prospective recording of symptoms is helpful to establish the cyclical nature of symptoms that differentiate premenstrual syndrome and premenstrual dysphoric disorder from other psychiatric and physical disorders. Physicians should tailor therapy to achieve the greatest functional improvement possible for their patients. Select serotonergic antidepressants are first-line treatments. They can be used continuously or only during the luteal phase. Oral contraceptives and calcium supplements may also be used. There is insufficient evidence to recommend treatment with vitamin D, herbal remedies, or acupuncture, but there are data to suggest benefit from cognitive behavior therapy.

RETRACTED: Calcium versus oral contraceptive pills containing drospirenone for the treatment of mild to moderate premenstrual syndrome: a double blind randomized placebo controlled trial.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editorial Board for the following reason: This single-author publication which reports the conducting of a large 3-arm randomised controlled trial, with no missing data from 210 recruited patients, has been questioned as implausible. The authors have been unable to provide supporting documents to provide an explanation.

Premenstrual syndrome: A mini review.

Premenstrual syndrome (PMS) is characterized by recurrent, moderate-to-severe affective, physical, and behavioral symptoms that develop during the luteal menstrual cycle and disappear within a few days of menstruation. Premenstrual dysphoric disorder (PMDD) is a severe and disabling condition that can affect personal relationships and occupational activities. PMS occurs in 30-40% of reproductive-age females; PMDD affects 3-8% of this population. Although the etiology of PMS is unclear, several theories suggest increased sensitivity to normal hormonal changes and neurotransmitter abnormalities. The diagnostic method of PMS is the Daily Record of Severity of Problems, which women with PMS can use to self-report several symptoms and their severity. Although combined oral contraceptives and serotonergic antidepressants are effective drugs, each is a different option for treating PMS/PMDD. Serotonergic antidepressants are the drugs of choice for improving both physical and mood symptoms. Combined oral contraceptives appear to primarily improve physical symptoms. Clinicians should consider each patient's situation individually. Other treatment options include lifestyle modification, cognitive behavioral therapy, and herbal medicine (e.g., chasteberry).

Effect of aerobic exercise on premenstrual symptoms, haematological and hormonal parameters in young women.

The objective of this study was to investigate the effect of aerobic exercise on premenstrual symptoms, haematological and hormonal parameters in young women. A total of 30 participants aged 16-20 years and complaining of premenstrual syndrome (PMS) were randomly assigned into two groups: a control group received vitamin B6 and Ca supplements once daily and a study group received the same medical treatment and participated in treadmill training three times per week for 3 months. A premenstrual syndrome questionnaire (MSQ), complete blood picture and hormone assays were performed for the assessment of all participants at the start and after the end of the treatment course. The study group showed a significant decrease in all post-treatment subscale symptoms, scores and total score. Haemoglobin, haematocrit, red cell count and platelet count were significantly increased, while mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) and white blood cell count showed no significant differences. There was also a significant decrease in prolactin, oestradiol and progesterone levels. In conclusion, aerobic exercise increases haemoglobin, haematocrit, red cell count and platelet count, and decreases levels of prolactin, oestradiol and progesterone, resulting in improvement of fatigue, impaired concentration, confusion and most premenstrual symptoms.

A review of treatment and management modalities for premenstrual dysphoric disorder.

Premenstrual dysphoric disorder (PMDD) affects 5 to 8 percent of women and can significantly decrease their quality of life. Symptoms generally present during the late luteal phase of the menstrual cycle and can affect women emotionally, behaviorally, cognitively and physiologically. This article reviews the clinical literature on PMDD and the evidence behind various methods of symptom management. Evidence suggests that a holistic approach, including lifestyle modifications, pharmacotherapy and cognitive behavioral therapy, is most beneficial for symptom reduction and improvement in daily functioning and quality of life.

A pilot study to compare fluoxetine, calcium, and placebo in the treatment of premenstrual syndrome.

Serotonin reuptake inhibitors and calcium supplements ameliorate symptoms of premenstrual syndrome. A comparison of these agents to placebo may guide treatment selection. The goal of this pilot study was to compare fluoxetine and calcium to placebo.We enrolled 39 women with at least 3 moderate to severe premenstrual symptoms and functional impairment. The trial compared fluoxetine (10 mg twice daily), calcium carbonate (600 mg twice daily), and placebo over the course of 4 menstrual cycles. The Inventory of Depressive Symptomatology, Premenstrual Tension Scale, Clinical Global Impression-Severity and -Improvement scales, and Daily Record of Severity of Problems were used to measure symptoms.Symptom improvement was greatest for the fluoxetine group, although significance was achieved only for the Daily Record of Severity of Problems (ß = -0.28; 95% confidence interval, -1.70 to -0.35; P = 0.02) and the Clinical Global Impression-Improvement (ß = -1.03; 95% confidence interval= -1.70 to -0.35; P = 0.04). The Cohen d effect sizes for fluoxetine relative to placebo were between 0.80 and 2.08, whereas the effect sizes for calcium were only between 0.10 and 0.44.Fluoxetine had clear therapeutic benefit for premenstrual syndrome, whereas the effect of calcium was much smaller. Results of this pilot do not support the need for a larger study that would compare these compounds.

Easing the burden of premenstrual dysphoric disorder.

It's much less common than premenstrual syndrome, but it can have a severe impact on your patient's quality of life. Here's how to recognize it and alleviate the symptoms.

Comparative study of effect of anuloma-viloma (pranayam) and yogic asanas in premenstrual syndrome.

The present study was planned to investigate the effects of Anuloma-viloma and specific yogic asanas in Premenstrual syndrome (PMS). The study group comprised of 60 females suffering from PMS between the age group of 18- 40 years, having 28-34 days regular menstrual cycle, further subdivided into 3 groups having equal number (n = 20) of subjects-group A (no intervention), group B (Anuloma-viloma) and group C (yogic asanas). Age-matched 30 healthy female subjects were taken as control. In all the subjects, a baseline recording of the systolic (SBP) and diastolic blood pressure (DBP) from the right arm was taken using an automated sphygmomanometer. The heart rate (HR/min), electromyogram (EMG; mV), galvanic skin response (GSR; komega), respiratory rate (RR/min), peripheral temperature (T; degrees F), were recorded simultaneously, on an automated biofeedback apparatus Relax 701. The subjects of group A and group B performed yogic exercises, regularly for 7 days prior to the expected date of menstruation for 3 consecutive menstrual cycles. The parameters were recorded again at the end of 7 days in each menstrual cycle. We observed that, in the group A and group B, HR, SBP, DBP, EMG, GSR and RR showed a very significant reduction (P < 0.001) and T rose more significantly (P < 0.001) after the 3rd menstrual cycle, when compared with their basal levels. On computing the percentage difference between the baseline and post values in all the three groups and than comparing this percentage difference, we found a y significant difference (P < 0.05) between the groups. In the present study, the relaxation response in the females suffering from PMS showed a reduction in an abnormally high basal sympathetic activity and a heightened relaxation response in both the study groups (group B and Group C) in comparison with group A.

[Correlation between neurotransmitters and neurosteroids and premenstrual syndrome patients of Gan-yang ascending syndrome and Gan-qi stagnation syndrome].

OBJECTIVE: To explore the pathogenesis of premenstrual syndrome (PMS), and the correlation between anger and depression and PMS of Gan-yang ascending syndrome (GYAS) and Gan-qi stagnation syndrome (GQSS) by detecting the neuro-reproductive hormones of PMS patients of GYAS and GOSS, thus providing theoretical reliance for diagnostic standards for clinical normative PMS. METHODS: Using techniques such as HPLC, HPLC-MC, ELISA, and radioimmunoassay (RIA), levels of serum sex hormones (follicle stimulating hormone, luteinizing hormone, estradiol, progesterone, testosterone, and prolactin), plasma neurotransmitters (gamma-aminobutyric acid, beta-endorphin, glutamic acid, dopamine, 5-HT, adrenaline, and noradrenaline), neurosteroids (allopregnanolone, pregnenolone, and dehydroepiandrosterone) in the follicular phase and the luteal phase of PMS patients of GYAS (30 cases) and GQSS (30 cases) were detected, and compared with the healthy control group (30 cases). RESULTS: There was no statistical difference in either index of the follicular phase among the 3 groups. Compared with the healthy control group, the testosterone level in PMS patients of GYAS in the luteal phase showed increasing tendency (P > 0.05). The levels of dopamine and 5-HT of PMS patients of GYAS in the luteal phase were higher and the gamma-aminobutyric acid level was lower than those of the healthy control group (all P < 0.05). The levels of adrenaline and noradrenaline of PMS patients of GYAS and GQSS in the luteal phase were higher than those of the healthy control group (all P < 0.05). The levels of allopregnanolone and pregnenolone of PMS patients of GYAS and GQSS in the luteal phase were lower, and the dehydroepiandrosterone level was higher than those of the healthy control group (all P < 0.05). The ratios of dehydroepiandrosterone/allopregnanolone and dehydroepiandrosterone/pregnenolone of PMS patients of GYAS and GQSS in the luteal phase were higher than those of the healthy control group (P < 0.05). CONCLUSION: The decreased levels of pregnenolone and allopregnanolone, increased dehydroepiandrosterone levels, and increased ratios of dehydroepiandrosterone/allopregnanolone and dehydroepiandrosterone/pregnenolone might be one of biological factors for anger and depression in PMS patients of GYAS and GQSS.

Premenstrual syndrome and premenstrual dysphoric disorder.

Premenstrual syndrome is defined as recurrent moderate psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation. It affects 20 to 32 percent of premenopausal women. Women with premenstrual dysphoric disorder experience affective or somatic symptoms that cause severe dysfunction in social or occupational realms. The disorder affects 3 to 8 percent of premenopausal women. Proposed etiologies include increased sensitivity to normal cycling levels of estrogen and progesterone, increased aldosterone and plasma renin activity, and neurotransmitter abnormalities, particularly serotonin. The Daily Record of Severity of Problems is one tool with which women may self-report the presence and severity of premenstrual symptoms that correlate with the criteria for premenstrual dysphoric disorder in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision. Symptom relief is the goal for treatment of premenstrual syndrome and premenstrual dysphoric disorder. There is limited evidence to support the use of calcium, vitamin D, and vitamin B6 supplementation, and insufficient evidence to support cognitive behavior therapy. Serotonergic antidepressants (citalopram, escitalopram, fluoxetine, sertraline, venlafaxine) are first-line pharmacologic therapy.

Steroid hormone hypersensitivity: clinical presentation and management.

Hypersensitivity to estrogens and progestogens is often undiagnosed. The condition has many manifestations, including premenstrual syndrome, dysmenorrhea, and impaired fertility. Diagnosis is confirmed by skin testing for inflammatory responses to small doses of the hormone, and desensitization with small doses of the hormone is the most appropriate form of management.

[Our experience with management of inherited thrombophilia during pregnancy. Preliminary report].

UNLABELLED: The physiologic mechanism that results in the occurrence of premenstrual syndrome (PMS) is not well understood. OBJECTIVE: Effective treatment in premenstrual syndrome with vitex agnus castus--femicur N in adolescent girls. [corrected]. MATERIAL AND METHODS: We have investigated 45 adolescent girls 14-16 years old for a 3 years period from march 2009 to march 2011. The first group of 23 girls were prescribed Femicur N 4 mg once daily for 3 month--90 capsules per course. The second group of 22 girls were given 40 mg of the study drug (Femicur N) twice a day, from the 19th day of the first day of the cycle for 10 days 3 month as the dose is 60 capsules per course. RESULTS: Our investigation showed that therapy with VAC-Femicur N in adolescents suffering from PMS was effective and the results were good. From 45 girls 20 girls (44.4%) were without any complaints and 13 girls (28.8%) had reduction of all premenstrual symptoms. In both groups premenstrual mastodynia in 13 girls (28.8%) has disappeard and with 4 girls (8.8%) complaints were redused.

[Study on estrogen receptors alpha and beta in the hippocampus of premenstrual syndrome model rats of gan-qi depression syndrome].

OBJECTIVE: To study the distribution pattern, the protein expressions, and changes of functional activities of estrogen receptor (ER) alpha and beta in the hippocampus of premenstrual syndrome (PMS) rats of Gan-qi depression syndrome (GDS), and to find out corresponding effect targets of Jingqianshu Granule (JG), thus providing clues for exploring the pathogenesis of PMS of GDS and the mechanisms of JG. METHODS: SD rats were randomly divided into three groups, i. e., the normal group, the model group, and the medication group, 7 in each. Resident intruder stress was used to establish the model in the model group and the medication group. JG was given to rats in the medication group at the dose of 10 mL/kg by gastrogavage while modeling. Equal volume of sterilized water was given to rats in the model group and the normal group, once daily, for 5 successive days. Then the location, protein levels, and ligand-binding capacities of ERalpha and ERbeta in the hippocampus of rats in three groups were detected using immunohistochemical assay, Western blot, and dextran-active carbon binding assay. RESULTS: There was no difference in the distribution pattern of ERalpha and ERbeta in the hippocampus of the three groups. In aspects of protein levels and estrogen-binding capacities of ERalpha and ERbeta in the hippocampus, CA1 and CA3 regions, they increased more obviously in the model group than in the normal group (P < 0.05), while they decreased more significantly in the medication group than in the model group (P < 0.05). CONCLUSION: Higher estrogen levels and enhanced expressions and activities of ERalpha and ERbeta in the hippocampus might be important mechanisms for PMS of GDS, which might also be the effect targets for JG.