Indian Write-Ups
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| Pre Menstrual Disorder In Women Dr. V R Badwar KEM Hospital,Mumbai |
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Premenstrual disorder is characterized by combination of emotional, behavioural and physical symptoms that occur one to two weeks prior to menstruation and subside with onset of menses. Low back pain is a common complaint by the patients during the premenstrual disorder. Anxiety and depression are commonly associated with premenstrual disorders in women. Everybody feels depressed at some time. However, the feeling of anxiety and depression is not the same as the illness of clinical depression. In anxiety and depression a patient must have had depressed mood or loss of interest or pleasure for at least 2 weeks, accompanied by significant distress or impairment, as well as at least 4 out of a number of classic symptoms. These include
Anxiety and depression is very common in women. One study has shown that 21.3% of women had experienced at least 1 depressive episode in their lifetime. Women have more problems with depression than men all over the world. It is estimated that about 75% of women of child-bearing age have some mood changes before menstruation. As many as 50% have a condition that people call premenstrual syndrome, or PMS, which is characterized by symptoms that come together during the week before menstruation. These symptoms include Physical symptoms
Emotional symptoms
In premenstrual syndrome the physical symptoms are the main presenting symptoms. Low back pain is one of the commonest presenting symptom seen in premenstrual syndrome. On the other hand, about 3% to 5% of menstruating women develop premenstrual dysphoric disorder (PDD), which can be a very impairing condition. Many women with PDD have physical symptoms, but emotional symptoms are the crux. Symptoms such as
are similar to those seen in a depressive episode, but the pattern is different. Here unlike in PMS, it is the emotional symptoms that the patient usually complains. The diagnosis in both the cases includes that the women must have the disorder almost every month. If a symptom occurs only in 5 out of 12 menstrual cycles, it cannot be attributed to PDD. Then, there have to be 5 or more symptoms within a characteristic time frame. The symptoms must be present, invariably, the week before the women starts menstruating, and must have disappeared by the week after she had finishes menstruating. The woman has to have these symptoms for at least a week, premenstrually, and they must disappear completely after she finishes menstruation. Commonly recommended treatments of premenstrual dysphoria include : Non pharmacological approaches
But some women need to do more than that. Anxiolytic drugs (e.g.. alprazolam) are been widely used, however they have a potential for dependence and are contra-indicated in an individual with a tendency towards substance abuse as they can lead to habituation. Antidepressants also have been found to be extremely effective for many women with premenstrual disorder. These women frequently, though not always, require treatment with antidepressants, such as the tricyclic antidepressants (e.g. imipramine, nortriptyline, dothiepin) or the selective serotonin re-uptake inhibitors (SSRIs e.g. fluoxetine, sertraline). Tricyclic antidepressants can be started with a daily dose of 50 – 75 mg and the dose can be increased to 100-150mg daily after a week. SSRIs can also be given. Antidepressants usually take 10-14 days to produce their antidepressant effect, though effects on sleep, anxiety and restlessness may occur after a few hours. The same tricyclic antidepressants should be continued for at least six weeks before being considered as ineffective for that person. Since pain is one of the main symptoms in premenstrual disorder medication like aspirin, paracetamol or NSAIDs can also be used. |
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