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Advancements in PME Treatment: From Conventional Therapies to Emerging Innovations

  1. Introduction

    1. What is Premenstrual Syndrome (PMS) and its Effect on Women’s Lives

      Premenstrual syndrome is a combination of physical, emotional, and psychological symptoms experienced by many females in the days and weeks before the menstrual period (1).

      PMS is known to occur during the luteal phase of the menstrual cycle, which is the period after ovulation and before menstruation (2).

      What exactly causes PMS is not known but it is believed to occur due to the fluctuation in hormone estrogen and progesterone levels.

      The symptoms of PMS vary from woman to woman and also range in severity. The symptoms experienced include:

      Premenstrual syndrome can impact a female’s life to a great extent. Some of the common effects include:

      • It can strain interpersonal relationships. The females may feel less patient and may get easily upset during this time, leading to conflicts and strained communications.
      • The work and school performance can be affected. Females may find it challenging to focus on tasks, make decisions, or perform optimally leading to decreased work or academic performance.
      • The emotional symptoms of PMS may impact a female’s well-being. It may make them feel more vulnerable and experience lower self-esteem.
      • The physical discomfort including breast tenderness, bloating, and cramps may make it difficult for women to engage in regular activities or participate in hobbies and exercise.
      • All these symptoms may affect the quality of life of a person. Severe symptoms may lead to social isolation, reduced participation in activities, and decreased overall life satisfaction.
      • In case the symptoms are severe and significantly impacting daily functioning, it is recommended to consult a healthcare professional for proper evaluation and management.
  2. Understanding Pre-Menstrual Exacerbation (PME)

    1. What is Pre-Menstrual Exacerbation (PME)?

      Pre-menstrual exacerbation refers to the worsening or intensification of pre-existing physical or psychological conditions during the premenstrual phase of the menstrual cycle (1).

      Some examples of premenstrual exacerbation include:

      • Pre-Menstrual Exacerbation of Mood Disorders: Females with pre-existing mood disorders such as major depressive disorder or bipolar disorder, may experience worsening of depressive or manic symptoms during the premenstrual phase. There may be increased feelings of sadness, irritability, mood swings, or heightened anxiety.
      • Pre-Menstrual Exacerbation of Anxiety Disorder: Females with anxiety disorder may experience heightened worry, restlessness, and physical symptoms like increased heart rate or shortness of breath.
      • Pre-menstrual Exacerbation of Physical Condition: Certain physical conditions may worsen during the premenstrual phase. For example, females with migraine may experience more frequent or severe headaches and those with chronic pain may notice increased pain intensity.
    2. Factors Contributing to Pre-Menstrual Exacerbation (PME)

      There are several factors that may contribute to pre-menstrual exacerbation (PME):

      • Hormonal Fluctuation: Rise and fall in estrogen and progesterone levels are considered significant factors in contributing to PME (3). These may influence neurotransmitter levels and sensitivity, thereby leading to mood changes and other symptoms.
      • Neurotransmitter Imbalance: The neurotransmitter imbalance affects serotonin, dopamine, and gamma-aminobutyric acid (GABA), which play a role in mood regulation. Imbalance or fluctuation may contribute to mood swings, irritability, and other emotional symptoms (4).
      • Sensitivity to Hormonal Changes: Some females may be more sensitive to hormonal fluctuation leading to exaggerated responses in symptoms during the premenstrual period.
      • Genetic and Biologic Factors: Females with a family history of PME or other mood disorders are more likely to experience premenstrual exacerbation (5).
      • Stress: Stress impacts hormonal regulation and overall well-being. Females with high levels of stress may be more prone to PME symptoms (6). Stress disrupts the delicate balance of hormones and neurotransmitters, worsening the symptoms of PME.
      • Lifestyle Factors: Lifestyle factors including activity level, nutrition, sleep, and caffeine and alcohol consumption may make a person more susceptible to PME.
      • Co-Existing Mental Condition: Females with preexisting mental conditions such as anxiety, and depression can be more susceptible to PME.
    3. Impact of PME on Daily Functioning and Quality of Life

      Pre-menstrual exacerbation (PME) significantly impacts the daily functioning and overall quality of life of females experiencing it. The emotional changes may make it difficult to manage stress, handle interpersonal relationships and cope with everyday challenges. They may find it difficult to focus on tasks, complete assignments, and make important decisions.

      PME may affect work performance and productivity. There may be irritability, mood swings, and increased sensitivity. They may find it challenging to engage in social activity, hobbies, or recreational pursuits during this time.

      All these things may impact daily functioning and decrease the quality of life.

  3. Conventional Treatment Options for Pre-Menstrual Exacerbation (PME)

    To treat PME, healthcare professionals may recommend various conventional treatment options, based on the severity of symptoms and individual needs.

    Some of the treatment approaches include:

    • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs including ibuprofen or naproxen can be helpful in easing the physical symptoms associated with PME. These medications may reduce inflammation and relieve pain.
    • Hormonal Birth Control: Oral contraceptives can help in regulating hormone levels throughout the menstrual cycle. This can regulate hormonal fluctuation contributing to PME.
    • Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs may be used to treat depression and anxiety. These regulate serotonin levels in the brain and alleviate mood symptoms associated with PME (7).
    • Cognitive-Behavior Therapy (CBT): CBT is a form of talk therapy that focuses on identifying and modifying negative thought patterns and behaviors. It can help people to develop healthier ways to respond to stressors and reduce the impact of PME on daily functioning.
    • Lifestyle Modifications: A change in lifestyle may help manage PME symptoms. Regular exercise, a healthy diet, and adequate sleep may contribute to overall well-being and help alleviate symptoms of PME.
    • Stress Management: Stress exacerbates PME symptoms. Stress management techniques may help reduce stress levels and improve emotional well-being.

    A healthcare professional should be consulted to determine the most suitable treatment option to manage PME. Keeping track of symptoms through a menstrual diary or tracking app can provide valuable information to guide treatment decisions.

  4. Emerging and Investigational Therapies for Pre-Menstrual Exacerbation (PME)

    Conventional treatment options are commonly used for PME, and emerging and investigational therapies show promise in managing PME.

    Some of the emerging and investigational therapies for PME include:

    • Gonadotropin-Releasing Hormone (GnRH) Agonists: GnRH agonists suppress the production of ovarian hormones, including estrogen and progesterone (8). Long-term use of GnRH may have side effects and considerations.
    • Calcium and Vitamin D Supplementation: Studies show that calcium and vitamin D supplementation have a positive impact on PME symptoms (9). Calcium may reduce the mood related symptoms and vitamin D may influence neurotransmitter function and mood regulation. However, more research is needed to establish the effectiveness and optimal dosing of these supplements.
    • Magnesium Supplementation: Magnesium is involved in various bodily processes, including neurotransmitter regulation and muscle function. Studies suggest magnesium supplements alleviate mood-related symptoms and physical discomfort (10).
    • Herbal Supplements: Certain herbal supplements such as chasteberry or evening primrose oil may have potential benefits in Pre-menstrual exacerbation (PME) management.
      Chasteberry influences hormonal balance and primrose oil has anti-inflammatory properties (11,12).
    • Mind-Body Therapies: Acupuncture, mindfulness meditation, and yoga can be promising in managing PME symptoms. These can help reduce stress, improve emotional well-being, and promote relaxation.
  5. Conclusion

    Pre-menstrual exacerbation profoundly influences women’s lives, affecting not only their emotional well-being but also their daily activities and overall life satisfaction. While traditional treatments such as NSAIDs, hormonal birth control, SSRIs, CBT, and various lifestyle changes have been standard in managing PME, the medical community is actively exploring innovative therapies. These include GnRH agonists, supplements like calcium, vitamin D, and magnesium, as well as herbal solutions and mind-body interventions.

    While early indications are promising for these emergent treatments, they require more extensive research to confirm their efficacy. As we navigate the path to discovering and deploying novel treatments for Pre-menstrual exacerbation, it’s imperative to underscore the importance of thorough research, regulatory oversight, affordability, long-term safety evaluations, tailored therapeutic strategies, and informed patient education. Together, these efforts aim to enhance the well-being and life quality of women affected by PME.

Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 10, 2023

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