| Although progestational agents have been widely used for gynecologic conditions, treatment options have usually been limited to synthetic agents with adverse effects and sparse patient acceptance. Recent food and Drug Administration approval of oral micronized progesterone (MP) has introduced therapy with a safe, effective, well-tolerated drug. This article reviews therapeutic indications for MP as illustrated in five case studies. Issues of patient compliance, individualized treatment plans, and patient partnership to obtain the most beneficial outcomes are discussed. ( info) |
2/57. Gonadotrophin-releasing hormone analogues: a novel treatment for premenstrual asthma. Premenstrual exacerbation of asthma, as reflected by a reduction in peak expiratory flow rate (PEFR), has been demonstrated in 40-100% of female asthmatics. Epidemiological data demonstrate that admission to hospital with an exacerbation of asthma occurs more frequently perimenstrually. Therapeutic interventions aimed at modifying this precipitating factor, however, remain limited. We report on a 32-yr old female with asthma in whom a marked increase in symptoms and reduction in PEFR occurred premenstrually, necessitating recurrent admissions to hospital. Frequent severe exacerbations resulted in the chronic use of oral maintenance corticosteroids. In order to suppress gonadotrophin secretion and ovarian function, a long-acting gonadotrophin-releasing hormone analogue was administered with a view to inducing a reversible menopause. This resulted in improvement in respiratory symptoms, the absence of PEFR dips premenstrually, a reduction in maintenance prednisolone dosage and no further hospital admissions during a follow-up period of 14 months. The authors propose that gonadotrophin-releasing hormone-analogue therapy is a rational and innovative adjuvant treatment worthy of further study in cases of severe premenstrual asthma. ( info) |
| We studied a sighted woman with premenstrual syndrome who showed menstrual changes in circadian rhythms. She showed alternative phase shifts in the sleep rhythm in the menstrual cycle: progressive phase advances in the follicular phase and phase delays in the luteal phase. Rectal temperature rhythm also showed similar menstrual changes, but the phase advance and delay started a few days earlier than changes in sleep-wake rhythm so that the two rhythms were dissociated around ovulation and menstruation. These results suggest that her circadian rhythms in sleep and temperature are under the control of ovarian steroid hormones and that these two rhythms have different sensitivity to the hormones. ( info) |
4/57. Intermittent, luteal phase nefazodone treatment of premenstrual dysphoric disorder. Three outpatients who fulfilled full DSM-IV diagnostic criteria for premenstrual dysphoric disorder (PDD) were successfully treated with intermittent (luteal phase) nefazodone. They received the medication at low doses of up to 100 mg/day (50 mg b.i.d.), for 2 weeks through the luteal phase of the menstrual cycle only. All the patients reported a marked symptomatic improvement, including full remission of their emotional symptoms, and two achieved in addition full remission of their somatic symptoms. Side-effects reported during the treatment were mild. The use of luteal phase nefazodone seems to be a promising treatment strategy for the management of PDD. It offers advantages over daily dosing throughout the menstrual cycle, such as reduced incidence and severity of side-effects, and avoids the stigma that may accompany the continuous use of psychopharmacological treatment, with the advantage that compliance may be improved. ( info) |
5/57. Antifungal activity against candida species of the selective serotonin-reuptake inhibitor, sertraline. Three patients with premenstrual dysphoric disorder (PMDD) and recurrent vulvovaginal candidiasis (VVC) underwent sertraline therapy (Tresleen, a selective serotonin-reuptake inhibitor; Pfizer) for PMDD. During sertraline intervention, patients had no recurrent episodes of acute VVC. Antifungal activity was observed for sertraline against various isolates of candida species. ( info) |
6/57. Increased premenstrual dosing of nefazodone relieves premenstrual magnification of depression. We report on 3 subjects with premenstrual magnification of major depression (PMMD) treated with nefazodone who benefited from a supplement of additional nefazodone premenstrually. During the 6-month study, subjects were given supplements of either additional nefazodone or placebo prior to the expected onset of menses (double-blind crossover design). Symptoms were assessed during the late luteal and follicular phases. All subjects showed significant improvement for the months in which they received nefazodone supplements, but not when given placebo. Premenstrual dose increase is a clinically promising intervention for women who experience PMMD. ( info) |
7/57. Homeopathic treatment for premenstrual symptoms. premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are well-documented disorders causing significant morbidity in the female population. Treatments prescribed do not necessarily reflect proven clinical effectiveness. A recent systematic review from the Exeter Department of Complementary medicine failed to endorse complementary therapies as a whole for treatment of PMS. However, a recent randomised controlled trial of homeopathic treatment for PMS confirms the clinical experience of homeopathic physicians that homeopathy is helpful in PMS. ( info) |
8/57. Perimenstrual psychosis among female adolescents: two case reports and an update of the literature. OBJECTIVES AND methods: Perimenstrual psychosis is an uncommon disorder, not included under the accepted classifications of functional psychoses. Our aim was to describe two Israeli female adolescents who fit this diagnosis. RESULTS: Both youngsters developed an acute psychosis a few days before menstruation, which subsided several days after bleeding, only to reappear in the same form in subsequent cycles. An extensive medical work-up did not show any significant disturbances, with the exception of anovulatory cycles in one youngster. Psychotropic treatment had no effect on the course of the psychosis. Treatment with a combined progesterone/estrogen contraceptive agent in one patient resulted in full recovery within several cycles. The second patient showed a spontaneous remission within four cycles. Follow-up for two to three years indicated a complete remission, with no need to reintroduce any psychotropic agent. CONCLUSIONS: Perimenstrual psychosis may represent a cycloid disorder or an atypical affective disorder, associated with anovulation. The use of psychotropic treatment is considered inconclusive, whereas hormonal agents may prove effective. ( info) |
9/57. Premenstrual asthma with seasonal variation. A 19-year-old woman had premenstrual asthma (PMA) usually from April through October each year with normal and regular menstrual cycles. When the monthly variation in the patient's PMA between 1984 and 1990 was compared with the monthly admissions of children for acute asthma in a hospital in this region, there was a great similarity in pattern between the two. Although she had high sensitivity to house-dust mites, the monthly pattern of her PMA did not coincide with monthly variations in the number of mites in house-dust in her home. ( info) |
10/57. Premenstrual tension syndrome with periodic bulimia nervosa: report of a case and review of the literature. Premenstrual tension syndrome (PMS) is well known in its epidemiology, etiology, symptomatology and treatment. However, PMS characterized by bulimic episodes is rare. We report a case of a 20-year-old university student who suffered from uncontrollable binge eating premenstrually for six months before visiting our clinic. She was obese without any other notable family or medical history except the PMS noted for two years. A daily food diary for two consecutive menstrual cycles showed that the mean differences in caloric intake between premenstrual and postmenstrual days of two menstrual cycles were 679 and 703 calories, respectively. The greater peaks in caloric level were noted within the third to fifth days prior to the onset of menstruation. All binge episodes occurred in the premenstrual period, especially within five days prior to menstruation. In this report, we will also review the literature on the relationship between PMS and dietary intake, as well as bulimia nervosa. ( info) |