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How Predex™ can help you ? Premenstrual syndrome
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Premenstrual Syndrome (PMS)

Premenstrual Syndrome ? You're Not Alone !

Just how prevalent a problem is premenstrual syndrome (PMS) ? Estimates vary widely, but some experts say as many as 75 to 90 percent of menstruating women in the United States may experience Premenstrual Syndrome.

While many women find Premenstrual Syndrome symptoms annoying or disturbing, perhaps 5% to 10% of women regularly experience symptoms so severe that they affect daily life activities. These women may be suffering from a more acute type of Premenstrual Syndrome known as PMDD (premenstrual dysphoric disorder), a newly-coined term now recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). Although PMDD was initially thought by some to be more marketing strategy than true medical disorder, many experts now believe it represents a distinct clinical condition [Endicott].

INFOBOX | How Do I Know It's Premenstrual Syndrome ?!

As the name implies, premenstrual syndrome is a broad umbrella for a wide constellation of troublesome symptoms which may appear 1-2 weeks prior to the onset of a woman's period, and often grow more severe during the days right before menstruation. For most women, these cyclical symptoms usually disappear within a few hours or days after menstruation begins.

Premenstrual Syndrome symptoms may include :

"bloating" or "water weight" gain;
swollen, tender breasts
sadness, anxiety, anger, and/or other mood changes
foggy thinking
food cravings, especially for salt, sweets, and/or carbohydrates.

A clinical diagnosis of the more severe variant of Premenstrual Syndrome known as PMDD requires a at least five of eleven specific symptoms that occur cyclically and severely disrupt daily activities.

Because both premenstrual syndrome and
premenstrual dysphoric disorder cover a wide variety of complaints, your doctor may order one or more laboratory tests to aid with diagnosis, and to rule out other disorders that can involve similar symptoms. Diabetes, for example, also can include symptoms such as an increase in appetite. Anemia and low thyroid function can similarly produce feelings of depression. Symptoms of a variety of psychological disorders can include crying jags or mood swings. And breast pain and swelling can also be associated with conditions such as fibrocystic breasts.

Before diagnosing premenstrual syndrome or
premenstrual dysphoric disorder, your doctor will likely ask you a variety of questions about the onset of symptoms and may order a blood analysis to test for thyroid function, anemia, and other conditions.


What Causes Premenstrual Syndrome ?

The underlying causes of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) remain a mystery. A "hormone imbalance" during the second half of the menstrual cycle was long suspected. One very small study observed, for example, that a particular type of estrogen (estradiol) is significantly lower in the blood of women with depression. [Young].

Other experts believe that it is not a lack of estrogen, but rather "estrogen dominance" over available progesterone during the luteal (pre-menstrual) phase that triggers Premenstrual Syndrome-related symptoms. [Lee] And yet other researchers theorize that an abnormal biochemical reaction to normal hormonal events produces these troubling symptoms. [Schmidt].

Whatever the underlying mechanism, decreased levels of serotonin (a "feel-good" chemical in the brain) appear to play a crucial role in the appearance of many Premenstrual Syndrome symptoms [Steiner].

INFOBOX | Reaching For A Food Fix?

Cyclical food cravings are often reported among Premenstrual Syndrome symptoms. But some of the very foods you crave could actually make PMS symptoms worse ! Here's why :

Sweets : can deplete the body of magnesium, an imbalance thought to contribute to headaches and depression.

Carbohydrates : may produce blood sugar swings, aggravating emotional ups and downs.

Salt : may increase water retention and bloating.

Alcohol : depletes the body of B-vitamins and may also tax the liver's ability to break down hormones, exacerbating hormonal imbalances.

Longer-term, over-eating may aggravate Premenstrual Syndrome by contributing to weight gain. The Premenstrual Syndrome link ? Fat cells produce low levels of estrogen, which can aggravate existing hormonal imbalances.


ILLUSTRATION | Luteal Phase & Premenstrual Syndrome Symptoms

Coming soon…


No Answer is Not An Answer

Hysterectomy accompanied by surgical removal of the ovaries is one (obviously extreme!) approach that does appear to alleviate Premenstrual Syndrome symptoms [Casper]. But for the vast majority of patients, medical management of Premenstrual Syndrome typically begins and ends with prescription drugs.

A variety of medications have proven effective for managing particular Premenstrual Syndrome symptoms, though as with any medication, potential side effects and interactions with other medication should be considered and carefully discussed with your doctor. These pharmaceutical options may include:

Antidepressants : A class of drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs) are sometimes prescribed for Premenstrual Syndrome-related depression, including fluoxetine, citalopram, paroxetine, and sertraline. These medications may be taken for the full monthly cycle, or only during the second (luteal) phase, during which PMS symptoms tend to appear. (To date, not all of these medications have been FDA-approved for use in the treatment of PMDD; if you suffer from this serious type of Premenstrual Syndrome, you may wish to discuss this issue with your physician).

Anti-anxiety drugs : In patients for whom SSRIs are ineffective, anti-anxiety medications such as alprazolam (a benzodiazepine) or buspirone are sometimes prescribed (though such use is considered off-label). Side effects with alprazolam include the potential for dependence.

Hormone therapy : Danazol (danocrine), a weak androgen (a "male" hormone naturally found in both men and women) more commonly used to treat endometriosis and fibrocystic breast disorders, is sometimes used for PMDD. This drug works by suppressing ovarian hormones. Side effects can include "masculinizing" changes plus weight gain, acne, and hot flashes, making this drug an uncomfortable therapeutic choice for many women.

GnRH agonists : Drugs known as gonadotropin-releasing hormone agonists (including leuprolide, histrelin, nafarelin, and goserelin) chemically prevent ovulation and halt the menstrual cycle, thus relieving Premenstrual Syndrome symptoms by interrupting the production of ovarian hormones. These drugs can be expensive, but do appear to significantly improve Premenstrual Syndrome symptoms [Muse], essentially producing an artificial menopause. Side effects can include menopause-like symptoms including hot flashes, bone loss, headaches, decreased libido, and mood swings or depression. Given the potential disadvantages, these drugs tend to be prescribed only for patients whose Premenstrual Syndrome symptoms are especially severe, and then only for short periods of time (3-6 months).

Pituitary-ovarian axis suppressants : Also known as oral contraceptives (OCs) or "the Pill", pituitary-ovarian axis suppressants are sometimes prescribed for Premenstrual Syndrome or PMDD sufferers. At present, oral contraceptives are not FDA-approved for relief of PMDD symptoms [Leather] , and their reported efficacy against Premenstrual Syndrome/PMDD symptoms is uneven. Results may depend in part on the particular formulation used, and on whether estrogen and/or other hormones are added. For some patients, the use of oral contraceptives may aggravate other pre-existing conditions, such as depression and migraines. Risks with these medications (though uncommon) include elevated blood pressure, blood clots, and stroke.

Dopamine agonists : Bromocriptine (an ergot derivative also used to treat Parkinson's disease) is sometimes prescribed to the alleviate painful breast swelling associated with Premenstrual Syndrome. Bromocriptine works by acting on dopamine receptors in the brain and central nervous system, increasing the availability of this important neurotransmitter. Adverse reactions are not uncommon, and may include nausea and other stomach discomfort, dizziness, and (with larger doses) irregular heartbeat and hallucinations.

Diuretics : "Water pills" like spironolactone may be prescribed to Premenstrual Syndrome sufferers during the luteal phase to help decrease bloating and breast tenderness. Side effects can include headache and lethargy. Diuretics can also adversely affect potassium levels in the blood, potentially disrupting electrolyte balances.

Not surprisingly, many Premenstrual Syndrome sufferers simply reach for over-the-counter remedies to treat Premenstrual Syndrome symptoms -- either in place of, or in addition to, prescription medications. Common remedies include over-the-counter diuretics to help reduce Premenstrual Syndrome-related bloating and water retention. Similarly, non-prescription pain relievers like aspirin, ibuprofen, or other NSAIDs (non-steroidal anti-inflammatories) may help reduce Premenstrual Syndrome-related headache and breast tenderness. (Side effects may include stomach irritation, and reduced clotting ability in the blood.)

While non-prescription preparations are generally safe to take as directed, remember that they are real medicine! Be sure to consult with your doctor and/or pharmacist about potential interactions with other prescription and non-prescription medications you may be taking.
For all too many women, however, there have been few effective Premenstrual Syndrome-coping alternatives -- until now!

Diosmin and Premenstrual Syndrome :

Scientific studies suggest diosmin may offer important help in reducing the uncomfortable, unwanted bloating and weight gain associated with Premenstrual Syndrome.

Just as diosmin reduces Chronic Venous Insufficiency-related edema (swelling) in the extremities by improving microcirculation and improving lymphatic drainage (see The Anatomy of Vein Problems, above), its active ingredient has been found to produce a "significant decrease" in painful premenstrual breast discomfort, in a year-long Italian study of 120 women. [Meggiorini].

Similarly, a very recent double-blind study that followed 30 women taking a flavonoid extract through four menstrual cycles noted "significant" improvement in subjectively-reported leg health scores, and concluded that flavonoids "may provide a new therapeutic direction" for treating premenstrual fluid retention. [Christie 2004].

Diet & Exercise :

You've heard it before: diet and exercise can help Premenstrual Syndrome symptoms!

One important place to start is simply reducing or eliminating "trigger" foods like salt, sugar, refined carbohydrates and alcohol that can increase unwanted symptoms. (See Reaching For A Food Fix? box, above.)

Caffeine -- another common culprit -- may not only exaggerate anxiety-related symptoms with its stimulant properties, but can also deplete calcium and B-vitamin levels.

Despite the reputed benefits of soy, a 2004 Japanese study found that soy/isoflavone consumption did not appear to significantly impact PMS symptoms. However, both high fat intake and low complex carb consumption were both "significantly correlated" with experience of Premenstrual Syndrome symptoms. [Nagata].

Dietary supplements
that have been frequently mentioned as helpful for Premenstrual Syndrome include:

Vitamin B-6 (pyridoxine) may help address Premenstrual Syndrome-related mood and depression issues. [Wyatt]. Moderation is important with this critical nutrient, however, so read package labels carefully; excessive doses may result in a form of nerve damage known as peripheral neuropathy.
Vitamin E, an anti-oxidant, may be helpful for tender, painful breasts as well as for combatting fatigue, nervousness, and depression.
Calcium (1,200 mg./day) may be beneficial for not only for reducing anxiety but also for bloating, food cravings, and other Premenstrual Syndrome symptoms. One study of 466 patients found that supplementation with calcium carbonate reduced overall Premenstrual Syndrome symptoms by 48% by the third menstrual cycle. [Thys-Jacobs 1998; Ward]. At least one researcher believes that Premenstrual Syndrome"represents the clinical manifestation of a calcium deficiency state that is unmasked following the rise of ovarian steroid hormone concentrations during the menstrual cycle." [Thys-Jacobs 2000].
Magnesium supplementation has also shown promise in treating such Premenstrual Syndrome symptoms as weight gain, breast tenderness, bloating and mood issues after the second month of treatment [Walker; Facchinetti]. While some researchers have suggested that women with severe Premenstrual Syndrome may have low magnesium levels in their blood [Sherwood; Rosenstein; Posaci], other researchers disagree. One tantalizing small study noted a synergistic effect on Premenstrual Syndrome-related anxiety symptoms when B6 and 200 mg. of magnesium were used together. [DeSouza]. Here again, recommended dosages should not be exceeded; too much magnesium can result in diarrhea. Magnesium can also interfere with certain prescription medications (including ACE inhibitors and certain anti-seizure drugs), so check with your doctor or pharmacist before using this supplement.
Evening Primrose Oil and other essential fatty acids are thought to be helpful in reducing breast tenderness and other inflammatory conditions. [German Commission E; Hardy]
Vitex agnus castus (chaste tree berry) may help reduce prolactins, and thus decrease Premenstrual Syndrome-related breast tenderness. [Hardy; German Commission E; Schellenberg].
St. John's Wort, already used extensively in Europe for depression, may offer significant benefits to Premenstrual Syndrome sufferers as well. One intriguing case note reported "much improvement" in a female patient with PMDD who was unable to continue SSRI treatment due to "intolerable gastrointestinal side effects," after a five-month period using St. John's wort (900 mg/day). [Huang].

Other Simple Steps :

Exercise tends to be a frequently overlooked but extremely potent weapon in the battle against Premenstrual Syndrome. It's not only a great stress-reducer, but can also help reduce body fat (a potential source of excess estrogen).

Other simple Premenstrual Syndrome-fighting steps you may wish to investigate include :

Topical progesterone creams : The subject of a certain amount of controversy, topical progesterone creams are also reported by many women to help balance hormones and reduce Premenstrual Syndrome symptoms.
Yoga, relaxation exercises, meditation, biofeedback : Many women report that these and other stress management techniques significantly improve their coping abilities during peak Premenstrual Syndrome-stress periods.
Acupuncture : This centuries-old therapy has not only abundant anecdotal evidence but a growing body of scientific work as well that appears to support its effectiveness. One study, for example, reported that acupuncture appears to help normalize the hypothalamic-pituitary-ovarian hormones. [Chen].
Light therapy : Exposure to bright, full-spectrum light for 10 to 15 minutes a day is a simple and often surprisingly effective tool against depression.


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