The use of prostaglandin inhibitors for the premenstrual syndrome.

The premenstrual syndrome (PMS) is a complex of symptoms that usually occurs seven to ten days before menses in large numbers of women. These symptoms typically cease during the 24 hours after the onset of menses. PMS affects many areas of the body, with each afflicted woman having her personal set of symptoms. Frequently encountered signs and symptoms include breast tenderness and swelling, weight gain, headache, abdominal cramping and bloating, food cravings, thirst, nausea, joint pain, acne, dizziness, hyperalgesia and one or more psychologic symptoms: irritability, lethargy and fatigue, depression, anxiety, hostility and aggression. Theories relating PMS to hormonal imbalance, vitamin deficiency or psychosomatic aberration have failed to explain this condition fully. Treatments using hormones, vitamins, oral contraceptives or diuretics have failed to relieve all the symptoms of PMS. The prostaglandin (PG) theory proposes that these nearly ubiquitous substances, produced in pathophysiologic amounts in brain, breast, gastrointestinal tract, kidney and reproductive tract, can trigger many of the PMS symptoms. If that is true, then a PG inhibitor could counteract excessive PG production and successfully control those PMS symptoms related to prostaglandin excess or imbalance. Therapy based upon this theory can proceed to the use of PG inhibitors in conservative steps. First, permanent deletion of xanthine-containing beverages (coffee, tea, cola and chocolate) from the diet can reduce nervousness, irritability and breast tenderness. Luteal phase salt restriction, with a mild diuretic used if necessary the last week before menses, adds to this effect. For the 20-25% of women who need more help, either a PG inhibitor or natural progesterone (to oppose the action of PGs), given when PMS begins, brings relief. In women with depressive PMS complaints, small daily doses of an antidepressant may prove helpful.