Use of complementary therapies by women attending a specialist premenstrual syndrome clinic.

In this study, we investigate the use of complementary therapies by women attending a specialist premenstrual syndrome (PMS) clinic in the UK. Data was collected via an anonymous questionnaire survey of 100 women attending the clinic. Results showed 91% of women had used at least one form of complementary therapy for the management of their premenstrual symptomatology although only 35% were current users. Over half (53%) felt that these therapies had been of some benefit. Prescribed medication for PMS was being used by 71% of women at the time of the questionnaire and 83% of these women were satisfied with the perceived success of conventional therapy. In conclusion, the vast majority of women attending a specialist PMS clinic in the UK have used complementary therapies to treat this chronic debilitating condition but few continue use long-term. Treatment may be instigated by the woman with advice from her informal support network and/or her physicians. However as use is so prevalent, but with few randomized controlled trials conducted to show their benefits or risks, it is important to improve awareness of these therapies, both in qualitative and quantitative terms. Satisfaction with prescribed medications did not appear to be influenced by complementary therapy use in this group of women.     

Premenstrual Dysphoric Disorder: Contemporary Diagnosis and Management

Most ovulatory women experience premenstrual symptoms (premenstrual syndrome, molimina) which indicate impending menstruation and are of little clinical relevance because they do not affect quality of life. A few women, however, experience significant physical and/or psychological symptoms before menstruation that, if left untreated, would result in deterioration in functioning and relationships. The precise etiology remains elusive, although new theories are gaining support in pre-clinical and early clinical trials. Refined diagnostic criteria allow better discrimination of this condition from other psychiatric diagnoses and the selection of symptom appropriate therapies that afford relief for most women. Pharmacotherapies (particularly selective serotonin reuptake inhibitors and SNRIs) represent the first-line treatment for premenstrual dysphoric disorder and severe, mood-related premenstrual syndrome. Continuous combined oral contraceptives have limited evidence for usefulness in premenstrual dysphoric disorder, whereas medical ovarian suppression is often recommended for patients who fail to respond or cannot tolerate first-line treatments (e.g., selective serotonin reuptake inhibitors). The use of cognitive behavioural therapies is promising, but it remains limited by sparse data and restricted access to trained professionals. A proper diagnosis (particularly the distinction from other underlying psychiatric conditions) is crucial for the implementation of effective therapy and alleviation of this impairing condition.     

Complementary and alternative medicine for labor pain: a systematic review

OBJECTIVES: The purpose of this study was to systematically review the literature for, and critically appraise, randomized controlled trials of any type of complementary and alternative therapies for labor pain. STUDY DESIGN: Six electronic databases were searched from their inception until July 2003. The inclusion criteria were that they were prospective, randomized controlled trials, involved healthy pregnant women at term, and contained outcome measures of labor pain. RESULTS: Our search strategy found 18 trials. Six of these did not meet our inclusion criteria. The remaining 12 trials involved acupuncture (2), biofeedback (1), hypnosis (2), intracutaneous sterile water injections (4), massage (2), and respiratory autogenic training (1). CONCLUSION: There is insufficient evidence for the efficacy of any of the complementary and alternative therapies for labor pain, with the exception of intracutaneous sterile water injections. For all the other treatments described it is impossible to make any definitive conclusions regarding effectiveness in labor pain control.     

Dietary supplements and herbal remedies for premenstrual syndrome (PMS): a systematic research review of the evidence for their efficacy

Many women with PMS use alternative therapies, although there has been little research to demonstrate their efficacy. This systematic review provides a comprehensive discussion of dietary supplements and herbal remedies commonly used for premenstrual syndrome (PMS), including calcium, magnesium, vitamin B6, evening primrose oil, Vitex agnus castus, ginkgo biloba and St John's Wort. Randomized controlled trials of magnesium and evening primrose oil have produced conflicting results, in contrast to the substantial evidence for the efficacy of calcium and vitamin B6. There are insufficient data to advocate the use of ginkgo biloba, Vitex agnus castus and St John's Wort, although preliminary data seem supportive. Greater standardization of PMS diagnosis and assessment, with randomized, double‐blind, placebo‐controlled trials using larger, representative samples, strict, prospectively confirmed diagnostic criteria and assessment of treatment efficacy, would help to clarify the role of these alternative PMS treatments. Although much of the clinical research is preliminary and/or inadequately controlled, this review will be relevant to the practicing clinician looking for greater understanding of the alternative therapies available to their patients with PMS.     

Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder: a meta-analysis

OBJECTIVE: To systematically review evidence of the treatment benefits of selective serotonin reuptake inhibitors (SSRIs) for symptoms related to severe premenstrual syndrome (PMS) and premenstrual dysphoric disorder. DATA SOURCES: We conducted electronic database searches of MEDLINE, Web of Science, Cochrane Library, Embase, PsycINFO, and Cinahl through March 2007, and hand-searched reference lists and pertinent journals. METHODS OF STUDY SELECTION: Studies included in the review were double-blind, randomized, controlled trials comparing an SSRI with placebo that reported a change in a validated score of premenstrual symptomatology. Studies had to report follow-up for any duration longer than one menstrual cycle among premenopausal women who met clinical diagnostic criteria for PMS or premenstrual dysphoric disorder. From 2,132 citations identified, we pooled results from 29 studies (in 19 citations) using random-effects meta-analyses and present results as odds ratios (ORs). TABULATION, INTEGRATION, AND RESULTS: Our meta- analysis, which included 2,964 women, demonstrates that SSRIs are effective for treating PMS and premenstrual dysphoric disorder (OR 0.40, 95% confidence interval [CI] 0.31-0.51). Intermittent dosing regimens were found to be less effective (OR 0.55, 95% CI 0.45-0.68) than continuous dosing regimens (OR 0.28, 95% CI 0.18-0.42). No SSRI was demonstrably better than another. The choice of outcome measurement instrument was associated with effect size estimates. The overall effect size is smaller than reported previously. CONCLUSION: Selective serotonin reuptake inhibitors were found to be effective in treating premenstrual symptoms, with continuous dosing regimens favored for effectiveness.     

Common complementary and alternative therapies for yeast vaginitis and bacterial vaginosis: a systematic review

This article is a systematic review of the literature regarding the most commonly used complementary and alternative medicine (CAM) therapies for yeast vaginitis and bacterial vaginosis. A search was conducted of all published literature on conventional search engines (PubMed, EMBASE, the Cochrane Registry, CINAHL, LILACS) and alternative medicine databases (Natural Medicines Comprehensive Database, Longwood Herbal Taskforce, and Alternative Medicine Alert), for all studies of the five most commonly used CAM treatments of vaginitis. Inconsistencies in definition of vaginitis, type of intervention, control groups, and outcomes prevented performance of a meta-analysis, and paucity of high-quality studies made ranking by evidence-based scales unsuitable. Lactobacillus recolonization (via yogurt or capsules) shows promise for the treatment of both yeast vaginitis and bacterial vaginosis with little potential for harm. Boric acid can be recommended to women with recurrent vulvovaginal Candidal infections who are resistant to conventional therapies, but can occasionally cause vaginal burning. Because of associated risks in the absence of well-documented clinical benefits, douching remains a practice that should not be recommended for the treatment of vaginitis. Finally, tea tree oil and garlic show some in vitro potential for the treatment of vaginitis, but the lack of in vivo studies preclude their recommendation to patients for the time-being. The available evidence for CAM treatments of vaginitis is of poor quality despite the prevalent use of these therapies. Well-designed randomized, controlled trials investigating the efficacy and safety of these therapies for vaginitis are needed before any reliable clinical recommendations can be made. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader will be able to list the most common complementary and alternative medicine therapies for vaginitis, summarize the data surrounding the efficacy of each therapy, describe the adverse affects of each therapy, and outline which therapies are recommended and not recommended for vaginitis.     

Use of alternative and complementary medicine in menopause.

OBJECTIVES: To review the clinical evidence available for the treatment of menopausal symptoms with alternative and complementary medicine. METHODS: The MEDLINE, PREMEDLINE and COCHRANE electronic databases for the years 1980-2002 were searched for articles concerning soy products, black cohosh, dong quai, acupuncture, ginseng and evening primrose oil. Studies pertaining to menopausal vasomotor symptoms, lipid profiles and bone mineral densities of postmenopausal women were included. The data from clinical trials were reviewed. RESULTS: Soy isoflavones slightly decrease total cholesterol and LDL levels. The clinical significance of this small change is yet to be determined. The synthetic isoflavone derivative ipriflavone increases bone mineral density in healthy peri- and postmenopausal women with moderate bone mineral densities. Although earlier reports have claimed that soy is beneficial for the improvement of vasomotor symptoms, recent data do not support this claim. There are insufficient data on the other alternative therapies for treating menopausal symptoms at this time. CONCLUSION: Alternative and complementary medicine may play a role in the management of menopause, however, well-designed large studies are still needed.     

Premenstrual Syndrome Its Nature, Evaluation, and Management

At least 25% of all menstruating women suffer from the premenstrual syndrome (PMS). The complex nature and incidence of PMS are explored. A PMS Clinic Nursing Protocol is provided to facilitate recognition, evaluation, and management of the syndrome. Both nonpharmacologic and drug therapies are included under interventions for the individual woman experiencing premenstrual dysphoria. Community management is also described.     

Lasting response to ovariectomy in severe intractable premenstrual syndrome

A total of 14 women with severe premenstrual syndrome unresponsive to conservative medical therapy were treated with danazol in doses sufficient to suppress cyclic ovarian steroidogenesis. In each case medical ovarian suppression resulted in complete relief from symptoms. For ongoing symptom relief, each woman elected to undergo bilateral ovariectomy and concomitant hysterectomy. Both medical ovarian suppression and ovariectomy with low-dose conjugated estrogen therapy afforded lasting relief from cyclic symptoms of premenstrual syndrome and a corresponding improvement in overall quality of life. We conclude that cyclic ovarian steroidogenesis is a powerful determinant for the expression of premenstrual symptomatology. Ovariectomy with low-dose estrogen replacement is an effective alternative for the woman with debilitating premenstrual syndrome who does not respond to conventional interventions.     

Platelet monoamine oxidase B activity in women with premenstrual syndrome

Several lines of evidence suggest a strong association between premenstrual syndrome and affective disorder. Similar psychological symptoms, behavioral manifestations, and biochemical etiologies have been reported. We attempted to evaluate the biologic interconnection between premenstrual syndrome and psychiatric disorder by investigating the platelet enzyme, monoamine oxidase B. The activity of this enzyme has been noted to be decreased in affective disorder, alcoholism, and psychiatric vulnerability. Platelet monoamine oxidase B activity, estradiol, and progesterone were assessed throughout one menstrual cycle in 13 women with premenstrual syndrome and 19 control subjects. No significant differences were noted between groups using these parameters. The study indicates that well-screened subjects with premenstrual syndrome are, as evidenced by the parameter of monoamine oxidase B, biochemically similar to normal control subjects.     

Premenstrual syndrome and premenstrual dysphoric disorder in adolescents

PURPOSE OF REVIEW: To review the current knowledge about the prevalence, diagnosis, and management of premenstrual syndromes in adolescents. RECENT FINDINGS: Large epidemiologic studies addressing adolescent premenstrual disorders, clinical presentation, and comorbidity with other disorders have yet to be performed. Randomized controlled treatment trials for teens with moderate-to-severe premenstrual syndrome or the more severe affective predominant, premenstrual dysphoric disorder still are sorely lacking. This review will present an updated review of the published studies with respect to premenstrual syndrome and premenstrual dysphoric disorder in adolescents in the context of the large body of literature regarding presentation, diagnosis, and treatment in adult women. SUMMARY: Premenstrual disorders likely start in the teen years. At least 20% of adolescents may experience moderate-to-severe premenstrual symptoms associated with functional impairment. Current treatment includes lifestyle recommendations and pharmacologic agents that suppress the rise and fall of ovarian steroids or augment serotonin.     

Herbal treatments for alleviating premenstrual symptoms: a systematic review

Premenstrual syndrome (PMS) is a condition of cyclical and recurrent physical and psychological discomfort occurring 1 to 2 weeks before menstrual period. More severe psychological symptoms have been described for the premenstrual dysphoric disorder (PMDD). No single treatment is universally recognised as effective and many patients often turn to therapeutic approaches outside of conventional medicine. This systematic review is aimed at analysing the effects of herb remedies in the above conditions. Systematic literature searches were performed in electronic databases, covering the period January 1980 to September 2010. Randomised controlled clinical trials (RCTs) were included. Papers quality was evaluated with the Jadad' scale. A further evaluation of PMS/PMDD diagnostic criteria was also done. Of 102 articles identified, 17 RCTs were eligible and 10 of them were included. The heterogeneity of population included, study design and outcome presentation refrained from a meta-analysis. Vitex agnus castus was the more investigated remedy (four trials, about 500 women), and it was reported to consistently ameliorate PMS better than placebo. Single trials also support the use of either Gingko biloba or Crocus sativus. On the contrary, neither evening primrose oil nor St. John's Wort show an effect different than placebo. None of the herbs was associated with major health risks, although the reduced number of tested patients does not allow definitive conclusions on safety. Some herb remedies seem useful for the treatment of PMS. However, more RCTs are required to account for the heterogeneity of the syndrome.     

Treatment of Mood and Depressive Disorders With Complementary and Alternative Medicine: Efficacy Review

There has been a steady increase in people with symptoms of depression over the past several years (since 2011). The further increase in stress and depression in the early part of the COVID-19 pandemic was accompanied by an increase in unmet mental health needs. Many have turned to complementary and alternative medicine (CAM) therapies such as bright-light therapy, yoga, meditation, and dietary supplements like St. John's wort or folic acid. The reliability of evidence for use of CAM therapies for depression has remained low. There are few randomized controlled trials (RCTs) in the current literature and poor methodology in many of the trials that are available. This state of the science review examines current published guidelines, meta-analyses, systematic reviews, and RCTs regarding use of CAM therapies in the management of depression.     

The effectiveness of GnRHa with and without 'add-back' therapy in treating premenstrual syndrome: a meta analysis

OBJECTIVE: To determine the effectiveness of gonadotrophin-releasing hormone analogues (GnRHa) with and without hormonal add-back therapy in the management of premenstrual syndrome. DESIGN: Randomised controlled trials were identified by searching multiple databases. SETTING: Exeter and North Devon Research and Development Support Unit and Keele University Academic Unit of Obstetrics and Gynaecology. POPULATION: Women with pre-diagnosed premenstrual syndrome and/or premenstrual dysphoric disorder. METHODS: A meta-analysis of published randomised placebo-controlled trials assessing the use of GnRHa in the management of premenstrual syndrome. The standardised mean difference for each individual study and subsequently an overall standardised mean difference were calculated after demonstrating the consistency or homogeneity of the study results. MAIN OUTCOME MEASURES: Overall improvement in premenstrual symptomatology and effectiveness of GnRHa with additional hormonal add-back therapy were the main outcome measures assessed in this analysis. A secondary analysis was performed to assess the effectiveness of GnRHa in treating physical and emotional symptoms. RESULTS: Overall standardised mean difference for all trials that assessed the efficacy of GnRHa was -1.19 (95% confidence interval [CI] -1.88 to -0.51). The equivalent odds ratio was 8.66 (95% CI 2.52 to 30.26) in favour of GnRHa. GnRHa were more efficacious for physical than behavioural symptoms, although the difference was not statistically significant. The addition of hormonal add-back therapy to GnRHa did not appear to reduce the efficacy of GnRHa alone; standardised mean difference 0.12 (95% CI -0.35 to 0.58). CONCLUSIONS: GnRHa appear to be an effective treatment in the management of premenstrual syndrome. The addition of hormonal add-back therapy to reduce side effects does not reduce efficacy.     

Taking an integrated approach: managing women with phytoestrogens

An integrated approach can be employed when counselling women about menopausal management options, where lifestyle, complementary therapies and hormone replacement therapy (HRT) are discussed. Women might opt to use an alternative approach to HRT for a variety of reasons, e.g. fear of side-effects and risks or contraindications to HRT. There are many choices of dietary and herbal approaches for menopausal symptoms, which essentially divide into food supplements and herbal medicines. The choice can often be overwhelming and confusing for the woman. Of concern, the evidence for efficacy and safety of some of these complementary therapies can be extremely limited or non-existent. In order to enable women to make a fully informed choice, it is important that, when a recommendation is made regarding a specific complementary therapy, it should focus on preparations for which a significant dataset exists for efficacy and safety and in which there is ongoing research and development. One of the most extensively studied food supplements has been the phytoestrogenic preparation containing red clover isoflavones. There have been six randomized trials thus far studying the impact on vasomotor symptoms, three of which have shown a significant benefit compared to placebo. There are also data from small randomized and observational trials showing positive outcomes for surrogate markers of osteoporosis and cardiovascular disease. A recent study using validated depression scales has shown that women using red clover isoflavones may also derive psychological benefits. Safety data are reassuring for the endometrium and breast, although further studies would be welcome, particularly in women with significant medical risks.     

Repeat antenatal glucocorticoids for women at risk of preterm birth: a Cochrane Systematic Review

Administration of antenatal glucocorticoids to women at risk of preterm birth has major benefits for infants but the use of repeat dose(s) is controversial. We performed a systematic review of randomized trials, using standard Cochrane methodology, to assess the effectiveness and safety of 1 or more repeat doses given to women at risk of preterm birth 7 or more days after an initial course. Ten trials were included involving over 4730 women and 5700 infants. Treatment with repeat dose(s) compared with no repeat treatment reduced the risk of respiratory distress syndrome (risk ratio, 0.83; 95% confidence interval, 0.75-0.91) and serious neonatal morbidity (risk ratio, 0.84; 95% confidence interval, 0.75-0.94). At 2- to 3-year follow-up (4 trials, 4170 children), there was no evidence of either significant benefit or harm. Repeat doses of glucocorticoids should be considered in women at risk of preterm birth 7 or more days after an initial course, in view of the neonatal benefits.     

Conditioning exercise and premenstrual symptoms

Exercise is commonly listed as a remedy for the premenstrual syndrome (PMS), although no study has proven that it is an effective therapy. Numerous reports have suggested that exercise is associated with improved mood and symptoms. In those reports, however, the diagnosis of PMS was not clearly documented, nor was the exercise carefully controlled. Preliminary evidence suggests that exercise training in ovulatory, sedentary women and intensified training in women athletes decrease mild premenstrual symptoms. Although conditioning exercise is associated with short luteal phase and anovulatory cycles, decreases in mild premenstrual symptoms occur prior to menstrual cycle changes. Controlled studies of PMS and exercise training may not only document an effective, nonpharmacologic therapy for PMS but also clarify the hormonal etiology of this complex biobehavioral phenomenon.     

Detecting changes in functional ability in women with premenstrual syndrome

There has been a lack of objective assessment of the disruptive effect that the symptomatology of premenstrual syndrome has on the functional performance of affected women. This study assessed the functional performance of women with premenstrual syndrome at four phases of the menstrual cycle. Twelve women with premenstrual syndrome and nine asymptomatic women were tested on four functional instruments at the menstrual, early follicular, early luteal, and late luteal phases. Two tests of a paper-and-pencil type measured perceptual parameters, and two tests involving manipulation of objects measured manual dexterity. Mean performance on the Crawford Small Parts Dexterity Test--Part II, which tests fine motor function, was better at the late luteal testing, compared to the early follicular testing, in asymptomatic women but was worse in the women with premenstrual syndrome. This difference was statistically significant (p = 0.015). No significant differences between groups in performance changes were observed for the other functional tests. The Crawford Small Parts Dexterity Test-Part II is an objective measure that is potentially valuable in therapeutic trials involving patients with premenstrual syndrome.     

Complementary and alternative medicine in pregnancy: a survey of North Carolina certified nurse-midwives

OBJECTIVE: To determine the prevalence and types of complementary and alternative medicine therapies used by certified nurse-midwives in North Carolina. METHODS: Surveys were sent to all 120 licensed certified nurse-midwives in North Carolina requesting information concerning their recommendations for use of complementary and alternative medicine for their pregnant or postpartum patients. RESULTS: Eighty-two responses were received (68.3%). Seventy-seven (93.9%) reported recommending complementary and alternative medicine to their pregnant patients in the past year. Forty-seven (57.3%) reported recommending complementary and alternative medicine to more than 10% of patients. The percentage of nurse-midwives who recommended each type of complementary and alternative medicine was as follows: herbal therapy (73.2%), massage therapy (67.1%), chiropractic (57.3%), acupressure (52.4%), mind-body interventions (48.8%), aromatherapy (32.9%), homeopathy (30.5%), spiritual healing (23.2%), acupuncture (19.5%), and bioelectric or magnetic applications (14.6%). The 60 respondents who reported prescribing herbal therapies gave them for the following indications: nausea and vomiting, labor stimulation, perineal discomfort, lactation disorders, postpartum depression, preterm labor, postpartum hemorrhage, labor analgesia, and malpresentation. CONCLUSION: Complementary and alternative medicine, especially herbal therapy, is commonly prescribed to pregnant women by nurse-midwives in North Carolina.     

Premenstrual syndrome

There has been a reluctance, until relatively recently, to accept premenstrual syndrome as a serious condition. Premenstrual symptoms occur in 95% of all women of reproductive age. Premenstrual syndrome occurs in about 5% of those women. Premenstrual syndrome patients are more susceptible to their normal ovarian hormone cycle. The increased sensitivity may be due to neurotransmitter dysfunction (possibly serotonin). However, the definitive aetiological cause is not known. There is a wide range of proposed therapeutic regimens for the treatment of premenstrual syndrome. This may result partly from the high but short-lived placebo effect. Second, the lack of long-term benefit leads to the quest for new methods. Although most of the therapeutic modalities have been assessed by randomized controlled trials, only a few of these were well-controlled trials. Here, the authors describe an evidence-based approach to management of premenstrual syndrome.