Premenstrual Exacerbation Research Articles

Longitudinal study comparing depressive female patients with and without premenstrual exacerbation

IntroductionThe aim of this study was to evaluate whether there are any differences in the clinical features of depression, personality and the G factor among women with and without premenstrual exacerbation (PE) of depression. Material and methodsNinety-nine outpatients diagnosed with major depression (DSM-IV) were interviewed twice. At baseline, the patients were not taking medication. The 74 patients who achieved remission (Hamilton rating scale for depression ≤7) after 16 weeks were evaluated again through the 16-personality factor (16-PF) questionnaire (5th edition) and the D48 (or Dominos) test. ResultsNo differences in clinical characteristics or prognosis were found between the two groups of women, except for the greater presence of seasonal features among women with PE. Women with PE also scored higher for self-control on the 16-PF and scored lower on the D48 (Domino) test. The logistic analysis showed that higher self-control scores increased the risk for PE in 51.3% of the sample, while higher scores on the D48 test decreased the risk in 8.6%. ConclusionsThere were no differences between the two groups in the clinical features or prognosis of depression, except for the higher rates of seasonal features in the PE group. In contrast, differences were found in personality traits and the D48 between the two groups.

Disturbo disforico della fase luteale e sindrome premestruale

Background Premenstrual Syndrome (PMS) comprises a wide variety of cyclical and recurrent symptoms, including physical, emotional, behavioral and cognitive symptoms that occur during the luteal phase of the menstrual cycle and rapidly resolve with the onset of menstrual bleeding. The lack of a clear diagnostic framework has brought to different epidemiological, etiopathogenetic and clinical conclusions over the years. Premenstrual Dysphoric Disorder (PMDD) is the most severe and disabling form of premenstrual disorder and occurs in 3–8% of cases, including always at least a dysphoric symptom. In some cases, it represents the premenstrual exacerbation of depression/anxiety symptomatology. Discussion and conclusions PMS/PMDD represent a model of the cyclical psychoneuroendocrine compromise deriving from women's adaptive responses which fluctuate monthly in response to periodic sexual hormone variations throughout the menstrual cycle. The complexity of the syndrome is likely to be related to the peculiar threshold of vulnerability of each woman which is modulated during the reproductive life span by several biological and even psychosocial factors. That being so, symptoms are extremely diverse, no biochemical markers are evident and therapeutic management is not always easy. Estro-progestin preparations for hormonal contraception may represent a suitable treatment strategy.

Variable Dosing of Sertraline for Premenstrual Exacerbation of Depression: A Pilot Study

Premenstrual exacerbation of depression (PMED) is a variation of major depressive disorder (MDD) in which symptoms worsen during the premenstrual period. Breakthrough symptoms of PMED may occur despite effective antidepressant treatment in the rest of the cycle. This pilot study is designed to evaluate the effectiveness of variable dosing in PMED using the antidepressant sertraline. Women diagnosed with PMED were started on sertraline (up to 50 or 100 mg/day). Those subjects demonstrating continued PMED on a constant dose (n = 9) were entered into a double-blind crossover protocol, receiving either placebo or an increase in sertraline premenstrually. Each subject was evaluated twice a month (follicular and luteal phase) by clinical evaluation, Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAM-D), and daily symptom diary and had blood collected for sertraline assay. Use of variable dosing resolved the PMED, such that there was no longer a significant difference in scores for the BDI and the HAM-D between the luteal and follicular phases during treatment with sertraline supplement (p = 0.32 and p = 0.53, paired t test, respectively). However, during the months with placebo supplement, the luteal and follicular phases showed a trend for differences for the BDI (p = 0.06, paired t test) and significant differences for the HAM-D (p = 0.02 paired t test); that is, the subjects retained the PMED pattern. Sertraline levels reflected the change in dosing pattern, with higher levels seen during the luteal phase during the months with sertraline supplement but no difference seen between luteal and follicular phases during months with placebo supplement (p = 0.07 and 0.69, paired t test, respectively). The use of variable dosing in PMED increases the effectiveness of treatment.

Rare Case of Autoimmune Progesterone Dermatitis Coexisting with Rheumatoid Nodules of the Ovary: Case Report and Review of the Literature

Autoimmune progesterone dermatitis (APD) represents a hypersensitivity reaction to endogenous progesterone. The condition presents with a variety of skin eruptions characterized by cyclical recurrent premenstrual exacerbations due to progesterone fluctuation during the menstrual cycle. We hereby describe the first case in modern literature of an association with a rheumatoid nodule of the ovary in a patient who presented with right-sided pelvic pain.

Leukotriene Receptor Antagonists: A Good Choice in the Treatment of Premenstrual Asthma?

The aim of this study was to investigate the effects of leukotriene receptor antagonists (LTRAs) on the premenstrual exacerbation of asthma (PMA). Twenty-four female patients with mild asthma were enrolled in the study. Patients were followed for three menstrual cycles and separated into two groups based on whether they exibit premenstrual worsening of asthma symptoms (n = 11) or not (n = 13). During the first month all were treated with only inhaled steroids (IS) (run-in period); during the second month they received IS plus placebo; and during the third month they were given IS plus montelukast. Furthermore, they were advised to use beta 2 -agonists as needed. Peak expiratory flow rate (PEFR) and symptom scores were recorded during the 3 months. Pulmonary function tests (PFT) and the levels of oestrogen, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were measured a week before the begining of the menstrual period. At the end of the 3-month period, it was observed that following therapy with montelukast, the patients with PMA showed significant improvement in PEFR variability and symptom scores when compared with the placebo group. Baseline FSH levels were higher, but FSH and other hormone levels and PFTs did not change in these groups. However, in the group without PMA there was no difference between the montelukast or placebo groups in PEFR variability, symptom scores, PFTs, and hormone levels. Based on the data in hand, it could be stated that LTRAs have ensured the control of symptoms and improved PEFR variability in patients with PMA by supressing inflammation. We are of the view that LTRAs would be a right choice in the treatment of patients with PMA.

Acute Worsening of Chronic Depression During a Double-Blind, Randomized Clinical Trial of Antidepressant Efficacy

Acute worsening of depression can negatively impact the outcomes of clinical trials of antidepressants and patient compliance to treatment. We hypothesized that acute worsenings would be more frequent in premenopausal women, relative to men or postmenopausal women, and in women who had demonstrated premenstrual symptom exacerbations (PMEs) prior to treatment, relative to those who had demonstrated no PMEs. Subjects diagnosed with DSM-III-R chronic major depressive disorder or double depression (dysthymia with concurrent major depressive episode) were randomly assigned between February 1993 and December 1994 to 12 weeks of double-blind treatment with flexibly-dosed sertraline or imipramine, with crossover to the alternate drug in the absence of response. A 6-point or more increase in the 17-item Hamilton Rating Scale for Depression relative to the (7-14 day) previous visit defined worsening. PME was assessed through daily diaries prior to treatment. There were 3582 evaluable visits attended by 554 subjects. Premenopausal women had a deteriorating depressive presentation at a greater proportion of their visits (8.6%) than did postmenopausal women (4.5%, p < .01) or men (5.9%, p < .01). The presence of PME at baseline was associated with more worsenings than the absence of PME (12.0% vs. 7.3%, p < .05). Results were similar whether the subject was treated with sertraline or imipramine. Nonresponse at treatment completion was more likely among subjects with worsening (p < .01). Dropouts were more likely than completers to have had an exacerbation at their terminal visit (p < .05). Acute worsening of depression was associated with reproductive variables and negatively affected clinical trial outcomes including early treatment discontinuation and nonresponse.

A comparison of the Tridimensional Personality Questionnaire in premenstrual dysphoric disorder and major depressive disorder

Objective Numerous symptoms of premenstrual dysphoric disorder (PMDD) overlap with those of major depressive disorder (MDD). This study investigates differences in novelty seeking, harm avoidance, and reward dependence between patients with PMDD, MDD without premenstrual symptoms or premenstrual exacerbation, and normal control subjects. Method The Chinese version of the Tridimensional Personality Questionnaire was administered to 51 PMDD, 39 MDD, and 52 normal control women during the luteal phase (between the menstrual cycle days 23 and 28). Results Harm avoidance score was significantly higher in women with MDD and PMDD than in controls, whereas reward dependence score was lower in women with MDD than in controls. However, Tridimensional Personality Questionnaire (except for the subscale of impulsiveness) did not distinguish between PMDD and MDD during the luteal phase. Conclusion The similarities between PMDD and MDD during luteal phase suggest a similar psychopathology.

Female hormones affect symptom severity in obsessive–compulsive disorder

There is circumstantial evidence that reproductive events can influence symptom severity of obsessive-compulsive disorder (OCD). We sent self-report questionnaires to 350 female outpatients with OCD to examine the relationship between the menstrual cycle, pregnancy, menopause, hormonal contraceptives, selective serotonin reuptake inhibitors and symptom severity of OCD. Yale-Brown Obsessive-Compulsive Scale scores were used at three serial time points during the menstrual cycle to assess symptom severity. One hundred and one out of 350 questionnaires (29%) were returned and completed. Forty-nine patients reported an exacerbation of OCD symptoms during the premenstrual period, nine during the menopause and 17 patients during pregnancy, whereas 11 patients mentioned improvement of OCD symptoms during pregnancy. Premenstrual dysphoric disorder could only partly explain a premenstrual exacerbation of OCD symptoms. Exacerbation of OCD could be related to reproductive events in a considerable number of patients, especially the premenstrum. Because reproductive cycle events influence the symptom severity of OCD, the menstrual cycle should be taken into account when assessing the severity of OCD symptoms during pharmacological studies.

Will Oral Contraceptives Join SSRIs as a First-Line Treatment Option for Women with Premenstrual Dysphoric Disorder?

10.2217/17455057.2.2.183 © 2 ‘It is assumed that ovulationrelated mechanisms trigger premenstrual symptoms in women with a vulnerability to CNS dysregulation. Several studies have identified abnormal serotonergic parameters during the entire menstrual cycle and the luteal phase in women with premenstrual dysphoric disorder.‘ s p t t h t D h a r T t s c Premenstrual dysphoric disorder (PMDD) is a combination of emotional, behavioral and physical symptoms that occur in the luteal phase of the menstrual cycle, abate shortly after the onset of menses, and cause impairment in social and role functioning [1]. The hallmark emotional symptoms of PMDD include irritability, anxiety or tension, mood swings and depressed mood. PMDD occurs in approximately 5% of menstruating women and is considered the severe end of the spectrum of clinically significant premenstrual symptoms. Reduced quality of life (QoL), increased healthcare costs and reduced productivity at work have been documented in women with PMDD [2,3]. Recent reviews and expert guidelines summarize the diagnostic criteria, recommended forms for the prospective daily charting of symptoms and the importance of identifying a premenstrual exacerbation of an underlying mood or medical illness prior to the initiation of treatment [4–7]. The etiology of PMDD is likely to be multifactorial, and many possible etiological factors have been reviewed [8]. It is assumed that ovulation-related mechanisms trigger premenstrual symptoms in women with a vulnerability to CNS dysregulation [9]. Several studies have identified abnormal serotonergic parameters during the entire menstrual cycle and the luteal phase in women with PMDD [8]. Studies also suggest an abnormal response to allopregnanolone and other γ-aminobutyric acid (GABA)-ergic agonists during the luteal phase of the cycle [10]. The

Expert Guidelines for the Treatment of Severe PMS, PMDD, and Comorbidities: The Role of SSRIs

The hallmark feature of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) is the predictable, cyclic nature of symptoms or distinct on/offness that begins in the late luteal phase of the menstrual cycle and remits shortly after the onset of menstruation. PMDD is distinguished from PMS by the severity of symptoms, predominance of mood symptoms, and role dysfunction, particularly in personal relationships and marital/family domains. Several treatment modalities are beneficial in PMDD and severe PMS, but the selective serotonin reuptake inhibitors (SSRIs) have emerged as first-line therapy. The SSRIs can be administered continuously throughout the entire month, intermittently from ovulation to the onset of menstruation, or semi-intermittently with dosage increases during the late luteal phase. These guidelines present practical treatment algorithms for the use of SSRIs in women with pure PMDD or severe PMS, PMDD and underlying subsyndromal clinical features of mood or anxiety, or premenstrual exacerbation of a mood/anxiety disorder.

Hidradenitis suppurativa: evidence for an endocrine abnormality.

Women patients with premenstrual exacerbation of hidradenitis suppurativa have been studied to determine if an endocrine abnormality can be detected. A functional disorder of the hypothalamopituitary axis was found in 13 patients with hidradenitis when compared with 9 controls. In response to a combined thyrotrophin releasing hormone and gonadotrophin releasing hormone test, the prolactin and TSH responses were significantly greater in the hidradenitis patients than the controls. No significant differences were found in the mean basal levels of oestrogen, progesterone, testosterone, dehydroepiandrosterone sulphate, T3 and T4. These results may reflect a disturbance of feedback signals from peripheral hormones, rather than a primary dysfunction of the control of specific anterior pituitary cells.

Quetiapine Discontinuation Syndrome

Ms. A, a 36-year-old woman with rapid-cycling bipolar II disorder and premenstrual mood exacerbation, was treated as an outpatient with lamotrigine, 400 mg at bedtime, and clonazepam, 0.5 mg t.i.d. Quetiapine, 100 mg at bedtime, was added for residual symptoms. Although the treatment was efficacious, Ms. A gained 20 lb in 6 months and asked to stop the medication. She was advised to decrease her quetiapine to 50 mg at bedtime. After 1 day, she reported nausea, dizziness, headache, and anxiety severe enough to preclude her normal daily activities. She was instructed to take quetiapine, 75 mg the next night, but her intolerable symptoms continued. They resolved when she returned to a dose of 100 mg at bedtime. A slower quetiapine taper of 12.5 mg every 5 days with the antiemetic ondansetron also failed. On a third attempt, prochlorperazine successfully reduced her discontinuation symptoms, although moderate nausea persisted for 2 days after the taper was completed. No other medications were changed, so quetiapine withdrawal was the most likely explanation for Ms. A's symptoms.

Self-reported premenstrual exacerbation of depressive symptoms in patients seeking treatment for major depression

Very little research has examined the frequency with which women with major depressive disorder experience premenstrual exacerbation (PME) of depression or the characteristics of those who report such worsening. The NIMH Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study provides a unique opportunity to evaluate PME in depressed women seeking treatment in primary care or psychiatric settings. This report presents data from the first 1500 participants enrolled in the STAR*D study. Premenopausal women with major depressive disorder were asked if they experienced a worsening of their depressive symptoms 5-10 days prior to menses. Those reporting PME were compared with those reporting no PME with regard to sociodemographic characteristics, course of illness features, symptom presentation, general medical co-morbidity, functional impairment, and quality of life. Of 433 premenopausal women not taking oral contraceptives, 64% reported a premenstrual worsening of their depression. Women who reported PME had a longer duration of their current major depressive episode [30.7 (S.D. = 73.7) months versus 13.5 (S.D. = 13.2) months; p=0.001], as well as greater general medical co-morbidity. Women reporting PME were also more likely to endorse symptoms of leaden paralysis, somatic complaints, gastrointestinal complaints, and psychomotor slowing, and were less likely to endorse blunted mood reactivity. PME is endorsed by the majority of premenopausal women with major depressive disorder and appears to be associated with a longer duration of depressive episode. PME is a common and important clinical issue deserving of further attention in both research and practice.

Irritable bowel syndrome, chronic pelvic inflammatory disease and endometriosis

Both irritable bowel syndrome and some gynaecological diseases can give rise to lower abdominal pain, which may result in diagnostic confusion. Disorders such as endometriosis and chronic pelvic inflammatory disease can be diagnosed definitively only by laparoscopy, which is seldom undertaken in the gastroenterological setting. It was the aim of this study to compare the symptomatology of irritable bowel syndrome with that of laparoscopically confirmed chronic pelvic inflammatory disease and endometriosis. A symptom questionnaire was administered to 50 women with irritable bowel syndrome and 51 gynaecological patients (30 patients with endometriosis, 21 patients with chronic pelvic inflammatory disease). As the symptoms of the two gynaecological conditions were so similar, the groups were combined for the purposes of comparison with irritable bowel syndrome. Patients with irritable bowel syndrome suffered significantly more upper abdominal pain, colicky pain and exacerbation of pain by food or stress. They also experienced more disturbance of bowel habit, distension and nausea. In contrast, the only gynaecological features that were more common in the gynaecological patients were intermenstrual bleeding, premenstrual exacerbation of pain and forniceal tenderness. The presence of gastrointestinal symptomatology, especially bowel dysfunction, in a woman with lower abdominal pain is suggestive of irritable bowel syndrome. However, the history may not be so helpful in detecting gynaecological disease.

Premenstrual exacerbation of depressive disorders in a community-based sample in the United States.

No published epidemiologic study has examined premenstrual exacerbation of depressive disorders (PME-DD) in a representative sample. Knowledge gained should indicate the burden of illness, suggest whom to monitor, and facilitate diagnosis. The objectives were to 1) ascertain the prevalence and predictors of PME-DD; and 2) test competing hypotheses that PME-DD is related to a) severity or history of depression, b) menstrual cyclicity in females in general, or c) a methodological artifact. Menstruating females (N = 900) from ages 13 to 53 living in urban or rural Illinois completed semi-structured psychiatric diagnostic interviews and rated symptoms of depression daily for two menstrual cycles; 58 had major depressive, dysthymic, or subclinical depressive disorders, and the remaining 842 were the non-depressed portion of the representative sample. Depressed females had 1.34 (95% confidence interval, 1.02-1.66) symptoms exacerbated premenstrually. The best model for predicting exacerbation contained only age. Older women more often had symptoms worsen. Symptoms during the follicular phase were most severe for clinically depressed, intermediate for subclinically depressed, and least severe for non-depressed participants, ps < 0.001. Consistent with the hypothesis that exacerbation is related to cyclicity in all females, the number of symptoms that became worse did not differ between groups, ps < 0.46. Given no symptoms in one cycle, the odds of having symptoms in the next cycle were 0.91. Only 56% of non-depressed females taking antidepressants were asymptomatic all month long; the remaining 44% still had symptoms premenstrually. Premenstrual exacerbation of depressive disorders is associated with deteriorated functioning over and above that already experienced by depressed females. Patients may be susceptible regardless of severity of depression, number of episodes, or remission status.

Premenstrual symptoms and premenstrual exacerbation in patients with psychiatric disorders.

The aim of the present study was to examine the frequencies of premenstrual syndrome (PMS) and premenstrual exacerbation (PME) of a number of psychiatric disorders in Chinese subjects. Premenstrual syndrome was assessed using a symptom checklist based on International Classification of Diseases (10th revision; ICD-10) criteria. Premenstrual exacerbation was defined as premenstrual worsening of pre-existing generalized anxiety disorder (GAD), major depressive disorder or dysthymic disorder (depressive disorders, DD), panic disorder (PD), or schizophrenia (SCH). Fifty outpatients were randomly sampled for each diagnostic group. Diagnosis was performed by psychiatrists using the structured Mini-International Neuropsychiatric Interview (MINI), and the frequencies of PMS and PME were compared for the different diagnostic groups. The PMS symptoms were reported by 78%, 80%, 68%, and 52% of GAD, DD, PD, and SCH patients, respectively, with 52%, 52%, 36%, and 20% fulfilling the definition of PME. No significant statistical relationships between diagnostic entities and family history of PMS, years of education, or age were demonstrated, but number of PMS symptoms was associated with severity of PME. No significant relationships were demonstrated between PME and marital status, parity, years of education, age, or family history of PMS. The results showed that high PME rates were noted for a sample of Chinese women with mental disorders, especially those with depressive and anxiety disorders.

Gender, Estrogen, and Schizophrenia

Most of the evidence to support an association between estrogen and psychosis is indirect and comes from clinical studies of gender differences in schizophrenia and from studies of fluctuating levels of psychopathology in different phases of the menstrual cycle. Our data, as well as those of other investigators, suggest a significantly later age at onset of schizophrenia in women than in men. There is somewhat more direct evidence from animal studies indicating that estrogen modulates dopamine systems in a manner similar to neuroleptics, although there are some inconsistencies in the literature. Few studies have examined the effects of estrogen administration in conjunction with neuroleptics on psychotic symptoms. We present a case report of a postmenopausal woman with schizophrenia who had an improvement in positive symptoms with estrogen replacement therapy. Long-term double-blind treatment studies are needed to investigate the effects of estrogen on psychotic symptoms in women with schizophrenia.

The ongoing silencing of women in families: an analysis and rethinking of premenstrual syndrome and therapy

Traditionally, explanations for premenstrual symptomatology have focused on the individual woman as the site of difficulties, and as the sole target of intervention. In contrast, from the perspective of a material‐discursive‐intrapsychic model, this paper will focus on the ways in which ‘PMS’ is experienced, constructed and dealt with in family relationships. Drawing on in‐depth narrative interviews conducted with women with moderate to severe premenstrual symptoms, it is argued that ‘PMS’ is closely tied to relationship difficulties and responsibilities; familial expectations and attributions for women's behaviour provide a discursive context for behaviour and emotions to be positioned as ‘PMS’; and that the ongoing self‐silencing and pathologization of women's emotions in families are key attributes of ‘PMS’. This suggests that a consideration of relationship issues should be central to any assessment or intervention for premenstrual symptoms, and conversely, that attention should be given to premenstrual exacerbation of relationship difficulties in family or couples therapy.

The PMDD Phenomenon: Breakthrough Treatments for Premenstrual Dysphoric Disorder (PMDD) and Extreme Premenstrual Syndrome (PMS)

Back to table of contents Previous article Next article Book ReviewsFull AccessThe PMDD Phenomenon: Breakthrough Treatments for Premenstrual Dysphoric Disorder (PMDD) and Extreme Premenstrual Syndrome (PMS)Leslie Hartley Gise, M.D.Leslie Hartley GiseSearch for more papers by this author, M.D.Published Online:1 Sep 2003https://doi.org/10.1176/appi.ps.54.9.1294AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This useful little book is both simple and comprehensible to the lay audience for whom it is intended, yet technical enough to be scientifically correct. Such an accomplishment is difficult given the paradoxes, uncertainties, and complexities in this field. The scope of The PMDD Phenomenon is comprehensive and the tone nonjudgmental. The authors "have experienced some form of these disorders" themselves, which makes them sensitive to the predicaments that women encounter in the face of jokes, ignorance, and negative attitudes about premenstrual problems. The book is enriched by extensive quotes from affected women. For example: "It's like having severe sunburn of your emotions." Hypotheses about the causes of premenstrual problems, myths about medication, and drug interactions are reviewed.In three cases a table would have been helpful: in the review of the hormonal changes during the menstrual cycle, in the discussion of the differences between depression and premenstrual problems, and in the discussion of the mechanism of action of medications that affect the serotonergic system. The table showing the patterns of symptom presentation across the menstrual cycle, taken from a classic 1995 article, is helpful.In general, this book covers complex ideas in plain language that only rarely lapses into jargon that may not be easily understood by everyone. More discussion could have been given to the mind-body problem and the interaction of genes and the environment. The important issues of empowerment and validation are addressed. An important point that is explained well is that women may incorrectly perceive that their work suffers during the premenstrual phase.Although premenstrual problems are both over- and underdiagnosed, this book stresses underdiagnosis and emphasizes the importance of rating symptoms on a daily basis. The discussion of differential diagnosis could have been extended, given that this is a complex issue that involves such confounders as drug and alcohol abuse, marital problems, and endometriosis.A whole chapter is devoted to premenstrual exacerbation, also called premenstrual magnification, which is poorly understood yet very common. The stigma of mental illness—which I prefer to call ignorance, which can be addressed through education—is also covered. The discussion of food cravings is reassuring, because women have been brainwashed into thinking that giving in to a craving is a sign of weakness. Nutritional supplements and complementary treatments such as herbal supplements, acupuncture, and relaxation are comprehensibly reviewed, as are light and sleep therapies.Little emphasis is placed on confirmation of ovulation, a problem in the literature that probably contributes to much of the confusion in the field. With the availability of home ovulation-detection kits, this is potentially less of a practical problem than it was in the past. The chapter on psychological therapies is somewhat confusing, because it both emphasizes and minimizes the impact of psychological factors. The second last chapter provides a practical approach for addressing premenstrual problems, and the book ends with advice for the significant others who are affected by premenstrual mood changes.The PMDD Phenomenon is the most comprehensive and balanced book of its kind and is likely to be very helpful to women who suffer from premenstrual problems.Dr. Gise is clinical professor of psychiatry at the University of Hawai'i and staff psychiatrist at the Maui Community Mental Health Center.by Diana L. Dell, M.D., F.A.C.O.G., and Carol Svec; Chicago, Contemporary Books, 2003, 239 pages, $14.95 softcover FiguresReferencesCited byDetailsCited byNone Volume 54Issue 9 September 2003Pages 1294-1294 Metrics PDF download History Published online 1 September 2003 Published in print 1 September 2003

The Premenstrual Period and Exacerbations in Multiple Sclerosis

The aim of this study was to assess whether an association exists between the premenstrual period and exacerbations of multiple sclerosis (MS). The subjects were 56 premenopausal patients with relapsing MS and a regular menstrual cycle. Data over the previous 2 years were gathered from a structured MS database and a comprehensive questionnaire. 42% had exacerbations starting in the premenstrual phase. Within this group the proportion of premenstrual exacerbations was significantly higher than in the remaining period of the menstrual cycle, and in 45% all exacerbations had started during the premenstrual phase. There was no relationship with the premenstrual syndrome, and there was no protective effect of oral contraceptives. Our results suggest that the premenstrual period triggers exacerbations in a subgroup of females with MS.