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#1
04.04.2007, 21:26
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ПМС (лечение) - выдержки из статьи
Treatment
Available therapies for PMS/PMDD range from lifestyle modification to surgery. Mild cases can be treated with lifestyle modification and nonpharmacologic options; severe cases deserve immediate and aggressive intervention. Nonpharmacologic Therapy. Lifestyle interventions for PMS/PMDD include institution of good sleep patterns and regular exercise. The patient should reduce or eliminate the use of tobacco, alcohol, and other drugs. Dietary treatment helps some patients. Certain vitamin and mineral supplements including vitamin D, vitamin E, calcium, and magnesium may be beneficial. diets high in carbohydrates and protein buttress the serotonergic axis. However, almost any intervention can be temporarily helpful, as the placebo response is quite high in this disorder. Some women may wish to treat their PMS/PMDD with herbal remedies. The use of herbal medicine and other complementary and alternative measures for PMS/PMDD has not been strongly validated in randomized, controlled trials Disposition. Benefit from nonpharmacologic interventions should be evident within two menstrual cycles. If the patient has shown no improvement at all during that time, the clinician should move on to pharmacotherapy. Pharmacologic Therapies for Somatic Symptoms. Bromocriptine (2.5 mg/day orally) has been promoted as a treatment for breast tenderness. Spironolactone (25 to 50 mg/day orally) has been given to alleviate bloating. Non-steroidal anti-inflammatory drugs can be effective treatment for dysmenorrhea Progesterone treatment has been shown to be ineffective for PMS/PMDD. Oral contraceptives are likely to aggravate rather than attenuate PMS/PMDD symptoms. Preliminary evidence suggests that a new oral contraceptive pill (Yasmin) containing a combination of low-dose estrogen and the progestin drospirenone can reduce water retention and other symptoms of PMS/PMDD. Pharmacologic Therapies for Affective Symptoms. Because the pathogenesis of PMS/PMDD probably involves an aberrant CNS response to normal ovarian function, the first-line treatment is to buttress CNS function with antidepressants. The SSRIs fluoxetine (20 mg/day orally), sertraline (50 mg/day), and paroxetine (12.5 mg once daily in the morning; may be increased to 25 mg/day) have been shown to be effective Although use of SSRIs can be limited to the luteal phase (10 to 14 days), that approach is impractical for many patients, who may have difficulty determining when to start the drug. Sertraline has a shorter half-life than fluoxetine. The advantage of a shorter half-life is that if the patient experiences unacceptable side effects, the side effects will fade more rapidly once the medication is discontinued. Buspirone is mildly effective for PMS/PMDD and may be a useful alternative in patients who find the sexual side effects unacceptable Benzodiazepine therapy with alprazolam, taken during the luteal phase, is appropriate for patients whose main symptom is anxiety Pharmacologic Interventions that Alter Ovarian Steroid Exposure. Patients with PMS/PMDD who fail to respond adequately to lifestyle modification, oral contraceptive use, and SSRI therapy or who refuse or are unable to follow such measures can be treated with gonadotropin-releasing hormone (GnRH) agonist therapy (e.g., leuprolide, nafarelin, or goserelin).They cannot be continued indefinitely without hormone replacement therapy because of concerns about the long-term deleterious effects of sustained hypoestrogenism, particularly bone loss. The synthetic androgen danazol can be used to temporarily suppress endogenous ovarian function and provide an androgenic environment. However, its side effects may be as problematic as the PMS/PMDD symptoms. Surgical Therapy. GnRH agonist therapy is expensive; therefore, if a patient is responding well to a GnRH agonist and has completed her childbearing, oophorectomy and hysterectomy may be a reasonable step.[39] Surgery may also be the therapy of choice for patients who have sustained improvement with GnRH-agonist therapy but experience recurrent symptoms with add-back hormone regimens. Postoperatively, these patients are given hormone replacement therapy with continuous estrogen alone. Continuing SSRI therapy may be indicated. Полный текст статьи здесь [Ссылки доступны только зарегистрированным пользователям ] 
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#3
05.04.2007, 13:46
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Цитата:
Эти выводы не совсем согласуются со многими ранее принятыми схемами, но при этом базируются на обширных исследованиях.
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Линейный вид
