Premenstrual Syndrome and Premenstrual Dysphoric Disorder in Adolescence

Faith Claman, MSN, CPNP, WHNP; Terri Miller, MSN, WHNP

Disclosures

J Pediatr Health Care. 2006;20(5):329-333. 

In This Article

Management

  1. A 2- to 3-month trial of non-prescription therapies, nutritional interventions, and lifestyle changes initially should be employed while the patient records her symptoms in her calendar/diary.

    1. Supplementation of calcium carbonate in a dosage of 1200 mg per day for three menstrual cycles

    2. Reduction of sodium, sugar, alcohol, and caffeine can minimize somatic symptoms and bloating

    3. Regular aerobic exercise 20 to 30 minutes 3 days a week, relaxation, stress management, and yoga may enhance general well being

    4. Eating frequent and smaller portions of foods high in complex carbohydrates

    5. Additional supplements (including vitamin B6, magnesium, vitamin E, chaste tree berry, primrose oil) have conflicting reports of effectiveness, as well as limited, substantiated research through random placebo-controlled trials.

  1. Non-steroidal anti-inflammatory drugs (NSAIDs) alleviate most physical symptoms.

  2. Spironolactone (Aldactone; Pharmacia, New York, NY)

    1. Effective for breast tenderness and bloating

    2. The recommended dose is 50 mg twice daily to begin 2 to 3 days before the anticipated symptoms until menses.

    3. Potassium levels should be monitored.

    4. Avoid use in those with impaired renal function.

  3. Combined oral contraceptives (COC)

    1. Recent controlled studies have shown that COCs with the novel progesterone formulation of drospirenone (Yasmin; Berlex, Wayne, NJ) reduced some affective symptoms of PMS and PMDD, as well as symptoms of bloating, breast tenderness, and acne (Freeman et al., 2001).

    2. Extended cycle administration (84 days of hormone-containing pills followed by a 7-day pill-free week) of a drospirenone-containing COC has been shown to reduce symptoms such as headache and mood swings (Sulak, 2005).

    3. Other therapies that have been tried but not recommended for the adolescent population include gonadotropin-releasing hormone agonists, pituitary-ovarian axis suppressants, anxiolytics, and dopamine agonists.

  1. Selective serotonin reuptake inhibitors (SSRIs)

    1. The SSRIs are considered the first line therapy for treatment of confirmed PMDD in women more than 18 years of age (Johnson 2004, Kaur et al 2004). Treatment during the luteal phase exclusively (10–14 days before menses) has shown to be as effective as full cycle dosing and with fewer adverse effects.

    2. Fluoxetine is currently labeled for use as continuous therapy in a dosage of 20 mg daily.

    3. Sertraline, in a dosage of 50 to 150 mg daily, is labeled for continuous therapy, or up to 100 mg daily for use during the luteal phase.

    4. Paroxetine is prescribed at 12.5 to 25 mg daily.

When prescribing SSRIs to adolescents, the clinician should be aware of the recent United States Food and Drug Administration (FDA, 2004) "Black Box" warning that indicates an increased risk of suicidality, but not suicide, among depressed children and adolescents taking SSRIs (FDA, 2004). The warning was specifically for the treatment of depression, and not for the treatment of PMDD. Consultation with a child psychiatrist would be the most prudent approach.

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