115 Premenstrual Syndrome and Premenstrual Dysphoric Disorder: Issues of Quality of Life, Stress and Exercise

The > symptomatology associated with the menstrual cycle in women ranges broadly in severity. >Molimina is the subclinical symptomatology affecting up to 90% of all women. >Premenstrual Dysphoric Disorder (PMDD) is the most severe form of > premenstrual syndrome (PMS). PMDD is debilitating and consists mainly of affective symptomatology that interferes with quality of life (QOL). While the etiologies of PMS/ PMDD remain unknown, symptoms are both physiological and psychological and as such an interdisciplinary biopsychosocial approach is needed to investigate the burden and decreased QOL in sufferers. This burden is considerable as up to 30% of women suffer from PMS and 5–6% have PMDD with nearly 4 years of projected disability for the latter. Published treatment guidelines recommend behavioral modifications as first-line therapeutic interventions for PMS with effective pharmacological options approved for PMDD. However, the efficacies for behavioral interventions are not well established, in part due to weaknesses in the research methods used to test a treatment effect, and resultant inconsistencies in findings. In addition, some strategies involving daily effort (e.g., >Cognitive-Behavioral Therapy) may be impractical in the face of the unique characteristics of cyclic symptoms. Other strategies such as aerobic exercise may be effective, but require motivation to perform during a period of time when sufferers feel particularly poor. As such, aerobic exercise by itself may be an unrealistic treatment option. Treatments that can reduce and/or manage > stress, elevate mood, and curb physical discomforts are needed. However, it may be impracticable to expect therapeutic success in all of these areas from a single intervention. Current research is therefore investigating complementary combinations of pharmacological and behavioral treatments as possible management strategies for PMS/PMDD. List of Abbreviations: AAFP, American Academy of Family Physicians; ACOG, American College of Obstetricians and Gynecologists; CAM, Complementary and Alternative Medicine; CBT, Cognitive Behavioral Therapy; DSM, >Diagnostic and Statistical Manual; FDA, Food and Drug Administration; HPA, Hypothalmic-Pituitary-Adrenal; HR-QOL, Health Related Quality of Life; ICD, > International Classification of Diseases; NIMH, National Institute of Mental Health; PMDD, Premenstrual Dysphoric Disorder; PMS, Premenstrual Syndrome; QOL, Quality of Life; SSRIs, > Serotonin Specific Reuptake Inhibitors