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Severe PMS Linked with Chronic Hormone Disorder

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The study involved 54 women, including 27 with PMDD and 27 who did not have it. The average age was 35. During the 20-minute test, pressure was gradually increased until the woman expressed pain, then it was continued until the woman could no longer tolerate it. Before the cuff was deflated, women were asked to rate how unpleasant and how intense the pain was.

"We found that the PMDD women were significantly more sensitive to the pain test," Girdler tells WebMD. "They had significantly lower threshold levels and tolerance times. They couldn't endure the test nearly as long as the control group, regardless [of] what phase they were in [in] their menstrual cycle. They also rated the test procedure as being significantly more unpleasant."

Moreover, the women's beta-endorphin levels also were significantly lower during both cycles at rest and during pain testing, says Girdler.

Her results support a long-standing theory that hormones in the body called endogenous opioids -- specifically, beta-endorphins -- may contribute to this disorder, because endogenous opioids not only regulate physical symptoms but influence mood as well, says Girdler.

Thus far, treatment of PMDD has been limited; most women are advised to make behavioral and dietary changes. "Folklore suggests that exercise helps, and indeed beta-endorphins are released during exercise. Unfortunately, the controlled studies of this disorder looking at exercise, diet, and herbal supplements have not been done, or have been done so poorly that we can't say definitively what works," says Girdler.

Some evidence suggests an association between histories of major clinical depression and women who develop PMDD, says Girdler. Large-scale clinical trials investigating antidepressants are being sponsored by the National Institutes of Health. Selective serotonin reuptake inhibitors (SSRIs) show the most promise in treating emotional symptoms of this disorder, says Girdler. (For more information on these trials, women can visit the NIH's new web site, http://clinicaltrials.gov/ .)

Valerie Ratts, MD, assistant professor of reproductive endocrinology at Washington University in St. Louis, has researched PMDD and tells WebMD, "I think it's very important if we can understand some of the reasons why people have PMDD. We need better treatments for it. Right now, we don't have much."

Simple measures can be tried first. Ratts advises women to get regular aerobic exercise, avoid foods containing refined sugars and caffeine (including sodas and chocolate), follow a well-balanced diet, and take a daily multivitamin. When they are having a bad day, women should try to reschedule important meetings for another time if possible, to inject a bit of laughter, and to give themselves small personal rewards. "Anything to make them feel better," she says.

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