Controversies in Premenstrual Syndrome: Etiology and Treatment

Abstract

It may be premature to discuss the ethical implications of the premenstrual syndrome (PMS) when the scientific foundations of the disorder are so poorly established. There are virtually no conclusive data available concerning its diagnosis or measurement; or specifying the precise endocrine and biochemical changes involved; nor are there any reliable studies enabling us to offer adequate treatment to patients. The present chapter attempts to identify some of the major deficiencies in our understanding of PMS and to assess the efficacies of the treat ments available. Much of the discussion will center around the failure of the majority of research studies to arrive at strict definitions and the inadequate means of characterizing and quantifying PMS when attempting to diagnose individuals and when trying to measure the day-to-day changes in symptoms. Two other important problems relate to etiology: the as yet unproven theories relating to progesterone deficiency, and the frequently reiterated phenomenon of water retention, which has, to date, not been shown to be a consistent component of PMS. Probably one of the most common and fundamental shortcomings in the study of PMS is the failure to include placebo controls in studies of therapy. This is surprising in a syndrome where the placebo effect of any therapy usually has been 40-50 percent, and occasionally greater (Sampson, 1979).