PMS: How Much Do We Really Know?
"Basically, PMS has been piecemealed. It's like the story of the five blind men and the elephant. One checked the trunk, another the leg and so on, but nobody has the full picture." --Dr. Susan Thys-Jacobs (1).
There has been much controversy over the biological factors involved in the mood disorders and discomfort felt by countless women before the onset of menses. The common term for this discomfort is pre-menstrual syndrome (PMS). PMS is a disorder involving hormonal changes that trigger disruptive symptoms up to two weeks prior to menstruation. While for many women the symptoms are not severe enough to require treatment, 12 % ...view middle of the document...
Dr. Sheryl Smith and colleagues in Philadelphia have devised a theory hypothesizing that PMS is caused by withdrawal of a woman's own hormones. The progesterone levels are increased during the second half of the menstrual cycle, and then there is a dramatic drop right before the premenstrual period. Progesterone, however, is converted to alopregnanolone, which acts like a sedative, increasing the potency of Gamma amino buteric acid (GABA). The presence of GABA produces mild euphoria. This theory hypothesizes that it is the sudden decrease that creates feelings of depression. The body, in effect, goes into withdrawal. She conducted an experiment in which rats were administered progesterone for three weeks and then induced them into withdrawal (both progesterone and alopregnanolone). As a result, the rats became more anxious. Studying the brain of these rats showed that this withdrawal changed the socket into which GABA connects, preventing GABA from calming the brain as it usually does. To counteract this effect, they used a substance which inhibited this outcome, and concluded that they could block the behavioral effects of the progesterone withdrawal. The implications for this hint at the need to create a drug that accomplishes the same results in humans (3).
More drug treatment theories
There have been a variety of treatments used to help alleviate PMS symptoms. Some address the psychological nature and others the physical. In the past, women have been described hysterical, and the treatments have been aimed at rectifying this abnormality. Psychotropic drugs have therefore been used in treatment, as well as tricyclics, tranquilizers, and selective serotonin reuptake inhibitors. However, when used for more than a few menstrual cycles, the limitations become apparent as they do not address the hormonal problems. There have also been many side effects including sleepiness and forgetfulness (2).To address the hormonal aspects of PMS, treatments including injection of aqueous progesterone have found to be effective. In addition, an English family practitioner named Kathrina Dalton, has also conducted studies administering Danazol, a drug taken continuously that controls the rise and fall of estrogen levels. Studies have shown the drug effective in 80% of the patients (2).
A slow-wave brain disorder
It has been proposed that PMS is due to a slow-wave brain disorder, characterized by an excess of delta waves. Other diseases characterized by slow-waves are ADHD, Chronic Fatigue Syndrome, Minor Head Injury, and Toxic Trauma. There have been successful treatments of these diseases as well as PMS with both biofeedback techniques and photic stimulation treatment, suggesting that both of these techniques address the brain wave disorder.
Since the symptoms of PMS are highly variable and not unilateral, it is best described as a condition of disregulation....