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Physical (headache, abdominal pain, e.g.), emotional (irritability, diminution of self-esteem, e.g.) and/or behavioral disturbances (fatigue, decrease of libido, e.g.) appear frequently during the premenstrual phase of menstrual cycles. Of moderate to severe intensity, these varied symptoms sometimes hinder the usual personal, social and/or professional functioning by generating significant suffering. Thus, premenstrual syndrome (PS) and premenstrual dysphoric disorder (PDD) are closely related to depressive disorders in many prior studies. In spite of solid links associating depression with premenstrual disorders in the literature, the psychological dimension of the premenstrual symptomatology still remains underestimated.The objective of this study is to examine the nature of possible relationships between a moderate premenstrual symptomatology and different modes of information processing with physical and emotional stimuli, such as somatization and physical anhedonia, well-known symptoms of depressive disorders.One hundred and five students in psychology from the François Rabelais university (France), aged between 18 to 50 years old (M=20.98, SD=3.43), were invited to fill in French versions of the Menstrual Distress Questionnaire [25] (Moos, 1991), the somatization subscale of the Symptom Check-List 90 [26] (DerogatisCleary, 1977), and the Physical Anhedonia Scale [28] (Chapman et al., 1976). Pearson correlation coefficients were calculated and a multiple regression analysis was conducted with Statistica software.Main results reveal that premenstrual symptomatology is positively related to somatization (r=0.58; P0.001) and negatively to physical anhedonia (r=-0.27; P0.05). Physical anhedonia (β=-0.20; P0.05) and somatization (β=0.55; P0.001) may take part in the appearance of a premenstrual symptomatology.These results allow us to enrich our knowledge on the origin and the nature of the premenstrual symptomatology, which would be physiological, psychological and social, in order to adapt and widen the therapeutic options by proposing, in parallel with the specific medical treatments, psychological interventions based on cognitive and behavioral techniques aiming a decentralization and a restructuration of the physical symptoms.

EGEA (Epidemiological study on the genetics and environment of asthma, bronchial hyperresponsiveness and atopy), a case control and family study including 2048 individuals, was initiated to look for environmental and genetic risk factors for asthma. A synthesis of the results obtained since 2002 on phenotypic and environmental aspects of asthma severity and allergy are presented in this article.The results support a role for hormonal factors in asthma severity and in various allergic markers of asthma. A greater body mass index was related to a more severe asthma in women with early menarche. Associations between markers of allergy (eosinophils, IgE and atopy) and hormonal dependent events in women (premenstrual asthma, menopause and oral contraceptive use) have been found. In asthmatics, exposure to agents known to be associated with occupational asthma, active and passive smoking were associated with an increased clinical asthma severity score. The study underlines the protective role of country living and exposure to pets in early life on allergy markers in adulthood, supporting the hygiene hypothesis.New hypothesis will be tested in the near future from the second stage of this survey.

Prementrual dysphoric disorder (PMDD) is considered to be a very severe form of the premenstrual syndrome (PMS) that occurs regularly in the last week of the luteal phase of the cycle and begin to remit after the onset of follicular phase and is absent in the week postmenses. What sets PMDD apart from PMS is its severity and its dominant psychiatric symptoms. PMDD includes depression, anxiety, tension, irritability and moodiness. Moreover, women with PMDD find that it has a very disruptive effect on their everyday lives. Although, many treatments have been used for PMDD over the years, PMDD remains difficult to be cured. Until recently, only few of these treatments were evaluated in carefully designed research studies and even fewer were shown to be effective. Here, we discuss the different therapeutic options for PMDD.

To study the prevalence of depression during pregnancy and its associated risk factors in Lebanese women.A prospective randomized study was conducted on a sample of 79 women consulting the gynecology outpatient department of Hotel-Dieu de France in Beirut, Lebanon who completed the Beck depression inventory as well as a 45 multiple choice questionnaire covering known risk factors implicated in depression during pregnancy.The 79 women of our sample were mostly over 20 years old, had a high educational level, and were almost all in the second or third trimesters of pregnancy. The prevalence of depression was 13.9%, without a significant difference between the different trimesters. Risk factors implicated were: personal or familial history of depression (OR = 8.1 and 4.9 respectively), a history of anti-depressive medication (OR = 12.4) and oral contraceptives (OR = 4.9), mood disorders associated with menstruation (OR = 8), major financial problems (OR = 10.5), medical complications associated with pregnancy (OR = 6.9), unwanted pregnancy (OR = 6.4), lack of support from the husband (OR=10.4), and poor quality of sexual relationship (OR = 13.3).Our results were comparable to those in the literature. Depression during pregnancy is a common problem in Lebanon, which should be treated and diagnosed early.

Premenstrual syndrome (PMS) is a recurrent disorder that occurs in the luteal phase of the menstrual cycle. It is characterized by intense physical, psychological, and behavioral changes that interrupt interpersonal relationships and disrupt the lives of affected women. Premenstrual syndrome is believed to affect 75% of women of childbearing age. Because no tests can confirm PMS, the diagnosis should be made on the basis of a patient-completed daily symptom calendar and the exclusion of other medical disorders. PMS symptoms occur during the luteal phase of the menstrual cycle and remit with the onset of menstruation or shortly afterward. The aetiology of PMS is still unknown uncertain, but are likely associated with aberrant responses to normal hormonal fluctuations during the menstrual cycle. A wide range of therapeutic interventions has been tested in the treatment of premenstrual symptoms. Most non-pharmacological interventions that have been proven efficacious require a series of interventions. If non-medical approaches are ineffective, drug therapy may be appropriate. Several pharmaceutics agents have been shown to relieve symptoms. Calcium carbonate and selective serotonin reuptake inhibitors have demonstrated excellent efficacy.

The premenstrual dysphoric disorder corresponds to a severe form of the premenstrual syndrome that mainly shows psychiatric symptoms. The incidence is about 3 to 8% of women in the reproductive age. The essential characteristics are depressive mood, a marked anxiety, emotional instability, and decrease of activity, appearing during the luteal phase and ceasing in the follicular phase of the menstrual cycle. Several factors are implied in the pathogenesis of this disorder. Neurobiological and psychobiologic effects concerning the metabolism of serotonin and the melatonin play a role. Several therapies were proposed. The most effective treatment seem to be the selective inhibitors of the of serotonin reuptake.

Menstruation is a biological phenomenon that has been subject of myths and taboos within and among various cultures. These myths distort the reality surrounding menstruation and create ambivalent feelings about the value and usefulness of this function outside of its necessity as mean of reproduction. Thus studies concerning menstruation need to take into account cultural and psychosocial factors that define the meaning, values and behavior associated with this biological phenomenon. According to several studies, 70% of women experience psychological faintness during this menstrual phase, 40% of them have these symptoms at each menstruation and between 3 to 8% of them suffer severely reacquiring medical support. This entity called premenstrual dysphoric disorder is defined by the presence of several symptoms (distress, tension, irritability, moodiness.) with a significant impairment in work or social functioning beginning during the week before and ending within a few days after the onset of menses. Several studies conducted over the past few years suggested that selective serotonin reuptake inhibitors (SSRIs) and serotoninergic tricyclic drugs may be more effective than other types of antidepressants in treating PMS symptoms. Two protocols are proposed; a continuous treatment or intermittent use during few days during pre-menstrual and menstrual phase for several cycles. The objective of the current study was to evaluate the prevalence of a potential premenstrual dysphoric disorder (PMDD) during one menstrual cycle, in a representative sample of general population of Casablanca, according the DSM IV criteria. On the other hand, a questionnaire, available from the authors, was used to explore socio-demographic data. Among 618 women interviewed, 310 met the criteria of a potential PMDD (50.2%). The mean age of the population with PMDD was 32.2 8 years ranging from 20 to 50 years; 54.8% of them were married, 33.9% of them were single and 66.5% of them had between 1 to 4 children. Two third of them were without a professional activity. During this premenstrual phase the following symptoms were found among the whole sample: marked depressive mood, feeling of hopelessness, or self-depreciation thoughts (77.7%, n=241%); difficulty of concentration (65%, n=201); marked change in appetite, overeating or specific food craving (82.8%, n=256); marked affective lability, with sadness tearful and increased sensitivity to rejection (65.8%, n=204); hypersomnia or insomnia (59.7%, n=185); subjective sense of being overwhelmed or out of control (55.7%, n=172); lethargy, excessive fatigability (91.6%, n=283); physical symptoms including breast tenderness, swelling, headache, joint or muscular pain, and a sensation of bloating and weight gain (81.9%, n=253). The most severe symptoms were fatigue and irritability. On the other hand, 73.9% of the sample had a disturbance in their socio-professional lives as a consequence to the psychological disturbances. Half of these women consulted a physician, mostly a general practitioner. These data are in accordance with the literature, confirming that this disorder is common and has a bad impact on mental health and on quality of life of the women suffering from PMDD.

Premenstrual Tension Syndrome (PMS) has always existed: it has been first described by an endocrinologist from New York in 1931. It is responsible for significant and psychological disorders which justify the study of its pathogenesis. Hormonal dysfunction has been demonstrated among women who are at risk for PMS; nevertheless, it has been shown that neurological transducers are also affected, such as GABAergic, serotoninergic and endorphinic systems. Interactions between the two systems allow to raise the hypothesis of an inbalance between GABAergic and progesterone derived neurosteroids in a psychoneuroendocrinological model. Based on this hypothesis, psychological symptoms can be efficiently treated by anxiolytic or antidepressant treatment. On the other hand, progesterone derivatives and, sometimes, diuretics, are useful on physical symptoms. As far as we know there is so far no single treatment of demonstrated efficacy in the PMS.

Central Nervous System acts as both a target and a regulator for the hormonal system. Premenstrual syndrome is a good example. Premenstrual dysphoria is wellknown and dreaded since a long time. Recent diagnostic criteria available for Premenstrual Dysphoric Disorder decrease the methodologic problems and might lead to a better knowledge regarding etiology and treatment. Alteration of serotonin regulation seems to be a promising area for further research. Efficacy of the inhibitors of serotonin reuptake accounts for it. Expected improvements will benefit to women and men as well....

Eating behaviours have been changing in our society for at least twenty years. Thus, they represent a good indicator of the functioning of a society or a person. Beyond these recent sociocultural variations, recent clinical and research data, particularly in chronobiology, showed clearly the influence of hormonal or seasonal changes in our eating behaviours. Actually, we observed that an important proportion of these cyclic turmoils can fit into other phenomena and cyclic pathologies: premenstrual syndrome, seasonal affective disorders, bipolar disorders, binge eating.

Premenstrual syndrome (PMS) constitutes a real health problem in France. Its etiology is still poorly understood. A national multicenter study has recently been devoted to this problem. The results are reported here.to improve awareness of the epidemiology of PMS and evaluate the therapeutic activity, on an open-label basis, of a micronized purified flavonoid fraction (Daflon 500 mg).the features of PMS were determined prior to the commencement of any treatment by using a daily self-assessment diary consisting of 24 items. The same diary was used for the 3 cycles during which patients were treated with Daflon 500 mg at the dose of 2 tabs/day without interruption. Weight and circumferential measurements were noted at least twice per cycle. Monitoring included telephone contact after one cycle and a final clinical evaluation after 3 cycles under treatment.of the 1,908 women selected by 887 gynecologists throughout the country, 1,724 contributed to the epidemiological study. It was confirmed that problems related to PMS were significant in 35% of cases and led to time off work in 7.4% of cases. One thousand four hundred and seventy three women completed the therapeutic trial. PMS disappeared completely in 37,4% of patients. The duration of PMS decreased on average by 2.6 days (p0.0001). Symptoms of congestion gradually lessened in terms of both frequency and severity by about 60%, the same applying to weight gain (-29% in comparison with the pre-treatment cycle). The safety/acceptability of Daflon 500 mg was considered to be very good by both patients and gynecologists.the diagnosis and management of PMS require precise evaluation. This study, the results of which require confirmation, justifies the inclusion of Daflon 500 mg among potential treatments offered to women suffering from PMS with a congestive component.

Pelvic congestion syndrome is encountered in three pathological situations: premenstrual syndrome, intermenstrual syndrome, chronic pelvic congestion syndrome. The first two syndromes, with a range of physical and/or psychological symptoms, are cyclical. Their pathogenesis is multifactorial. Hormonal and circulatory factors are essentially blamed. Treatment is most often based upon combinations of progestogens and venotonics. The third syndrome, that of chronic pelvic congestion, is characterised by long term pelvic pain and raises etiopathogenic problems which remain only partially solved and in which a vascular role may sometimes be recognised. Endovaginal ultrasonography with colour-coded Doppler and celioscopy sometimes reveal pelvic varicose veins and indicate their responsibility for such pain, after having eliminated specific pelvic pathology (post-infectious or post-operative inflammatory sequelae of pelvic tissue, rupture of the broad ligaments, endometriosis, etc.). Treatment is above all medical, based upon hormone therapy acting upon venous receptors, venotonics which decrease the consequences of stasis, intermittent courses of anti-inflammatory agents and antibiotics when there is inflammation secondary to local infection. These various types of treatment may be combined. Surgical treatment should be restricted to certain carefully assessed cases only.

Progesterone has been the first isolated gestagen. After a short review on the physiology of secretion of progesterone some pharmacologic actions are considered by the authors. Among gestagens, derivatives of pregnane are of special interest, particularly because of fewer, notably androgenic, side effects. After reviewing commercial French and Swiss products the authors focus on three applications: the premenstrual syndrome where progesterone is of interest for local and systemic administration the perimenopause in which several pathologies treatable by gestagens occur Finally the menopause in which progesterone is important in view of its physiologic role. Among the reasons to use progesterone combined with estrogens during menopause, prevention of endometrial cancer is the most important but other advantages are also noted. The authors discuss risk factors for breast cancer during treatment with gestagens in menopause. Finally the authors review compliance and underline the importance of new treatment schedules for the menopause: Continuous treatment, on-demand treatment or menstruation every 3 months.

The growth of the mammary gland during the active genital period depends on a delicate balance between the action of the two major female sex steroid hormones, estradiol and progesterone. The regulation of growth and maturation of the gland primarily depends on the combined action of estradiol and progesterone. Breast epithelial proliferation is maximal during the luteal phase of the menstrual cycle. While estrogen appears to be the major impetus to the proliferation of mammary cells, the effect of progestin is subject to debate. Progestins have either a positive, modest or no growth effect or may even inhibit growth. Progestins could stimulate the development of malignant cells in contrast to normal or non-malignant cells. It is difficult to extrapolate in vitro results to the human breast. There is presently no direct evidence that progestins regulate the concentration of estrogen receptors (ER) in normal breasts. Furthermore, it is possible that each type of progestin may have different effects. Most studies suggest that progestins are effective in the treatment of premenstrual syndrome and benign breast disease. The therapeutic basis for the use of progestins is the suppression of pituitary-ovarian function the reduction of the effect of estrogen on breast tissues. Whether progestins give protection against breast cancer is less clear. If they do, the mechanism is not the same as that of the endometrium [down-regulation of ER, increase of 17 beta-hydroxysteroid dehydrogenase activity (E2DH)]. High doses of oral synthetic progestins are effective in the treatment of breast cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

The efficacy of standardized Ginkgo biloba extract (EGb 761) in treating congestive symptoms of premenstrual syndrome (PMS) was evaluated in a controlled multicentric double blind study versus placebo. The population studied was a group of 165 women aged between 18 to 45, in genital activity period, suffering since 3 cycles from congestive premenstrual troubles during at least 7 days per cycle. The characteristics of patients and PMS were the same in both groups (EGb 761 and placebo). The observation of one menstrual cycle confirmed the diagnosis of PMS. Then, during the 2 following cycles, each patient received either EGb 761 or placebo from the 16th day of the first cycle till the 5th day of the next cycle. A double evaluation of the symptoms was realized by the patient using a daily rating scale (auto-evaluation), by the practitioner during visits at the premenstrual phase before and after the two cycles treatment. From 165 patients included, 143 observations were available. With a good acceptability, EGb 761 was effective against the congestive symptoms of PMS, particularly breast symptoms with a statistical significance between EGb 761 and placebo. Neuropsychological symptoms were also improved. EGb 761 is an alternative of interest to therapeutics already used in treating PMS or can be associated without any inconvenience.

The efficacy on bodyweight and the acceptability of a three month treatment with dexfenfluramine (Isoméride), combined with a prescribed diet, were evaluated in 336 women followed by a gynecologist for overweight. These women were divided into three groups, those in the sexually active age group (80%) and perimenopausal and post-menopausal women (20%) and had the following characteristics: mean bodyweight 80.2 +/- 0.6 kg; excess bodyweight 35.0 +/- 0.5% of theoretical ideal weight, mean bodyweight index = 30.6 +/- 0.2 kg/m2. Simultaneously with the weight loss, a study of the change in gynecological symptoms was carried out at each consultation and for each group. Investigation of the bodyweight showed that 80% of the patient who followed the treatment for three months lost weight, the mean loss being 7.2 kg or 41.9% of the initial excess weight. Simultaneously with this loss of weight, there was an improvement in the gynecological symptoms in all three groups. These symptoms included those seen in the premenstrual phase (sexually active age group) and menopause-related symptoms in the perimenopausal and post menopausal groups. The acceptability and safety of Isomeride were also confirmed in this study.

The success of treatment aimed at improving manifestations of venous insufficiency appears today to be closely linked to a therapeutic impact on blood viscosity and the macrorheological parameters upon which it depends. This double-blind placebo-controlled trial of troxerutine was designed to evaluate changes during treatment in rheological abnormalities in 60 women with vulval varicosities and venous insufficiency of the lower limbs, half in the context of premenstrual syndrome and half in pregnant women from the 4th month on. Initial examination revealed no significant difference between the treated and control groups from a clinical and rheological standpoint in the gynecological and obstetric categories. Analysis of results showed that a high dose of troxerutine was associated with a very marked improvement in symptomatic parameters by the first month of treatment with a significant correlation between clinical criteria and rheological parameters in pregnant women as well as in those with a premenstrual syndrome. These data were confirmed by excellent acceptability as well as subjective assessment by patients after 4 months' treatment at the dosage of 4 g/d.

Pelvic congestion syndrome is common to three pathologies: premenstrual syndrome, intermenstrual syndrome and chronic pelvic fibrous congestion syndrome. The two first syndromes are well-known. They are periodical and hormonal treatment is relevant in premenstrual syndrome (all forms of progesterone and provascular treatment). Chronic pelvic congestion syndrome or fibrous congestion is linked with fibrous changes of the subperitoneal cellular tissue after more or less lasting chronic congestion. It is sometimes secondary to low noised and unknown sepsis (Bret and De Brux fibro-sclerous pelviperitonis). It is usually linked with the traumatical rupture of cellular pelvic tissue from obstetrical etiology (Masters and Allen syndrome). In varicocele, uterine plexus and ilio-lumbar ligament, hormonal action has been suggested. Three signs overnite polymorphic clinical study: deep dyspareunia, moving cervix, uterus retroversion. But primitive or secondary congestion is only in fact evoked by coelioscopy even with its limits. When coelioscopy is negative, hysterophlebography will be achieved and will visualize sometimes extremely pelvic plexus vasodilatation. As function of findings lesions, treatment lays down 3 principles: first principle not to abuse with surgery except in case of testing patent ligamentary lesions. Second principle to prescribe a polyvalent general treatment with triade antibiotic, antiinflammatory and phlebotonic drugs. Third principle to be preventive by improving obstetrical exercise as usually this syndrome succeeds to a more or less traumatic delivery.

The cyclic fall in oestrogen level associated with the beginning of menstruations produces common migraine in 10 to 20 p. 100 of women in the general population. In women who already have migraine, the menstruations coincide with triggering or worsening of the attacks in 60 p. 100 of the cases. About 1 out of 10 women who do not have spontaneous menstrual migraine begin to suffer regularly as soon as they take an oral combination contraceptive. High doses of antigonadrotropic progestogens make the attacks worse because they herald or enhance the hypoestrogenaemia. Insufficient doses of oestrogens administered orally induce brief daily episodes of increased, then decreased oestrogenic stimulation, and they also facilitate the occurrence of migrainous attacks. The best available preventive treatment consists of cyclic percutaneous administration of oestradiol in doses that are sufficient to stabilize blood oestradiol levels at 60-80 pg/ml during the critical week. This treatment is the only one that prevents migrainous attacks and preserves the menstrual cycle. Obviously, it only benefits women with menstrual migraine, and fluctuations in oestradiolaemia are only one of the multiple precipitating factors of migrainous attacks.

The purpose of this article will be to present informations regarding two new progestational++ medications: nomegestrol acetate (Lutenyl), and promegestone (Surgestone) in order to make use of them in our prescription habits. We will situate them in relation to various groups of progestative medications and present their specific properties and their tolerance. Finally, we will demonstrate their role in contraception and their effectiveness in the main indications of progestative medications.

After a clinical and physiopathological review of the premenstrual syndrome, the author reports six cases of patients showing these symptoms who were treated exclusively by acupuncture. The clear improvement shown makes it worthwhile to continue the trial and to extend it to include other domains of functional gynaecology.

This article reviews several different articles which have contributed to an understanding of the harmful or beneficial effects of oral contraceptives (OCs) on various diseases. The Royal College of General Practitioners study found that current OC users compared to women who had never used OCs had relative risks of .52 for menorrhagia, .37 for dysmenorrhea, .65 for irregular cycles, .72 for intermenstrual bleeding, and .71 for premenstrual syndrome. Several studies found combined OCs to offer protection against ovarian cysts. Microdose progestin only pills did not ameliorate most menstrual problems and aggravated ovarian cysts. Despite some theoretical grounds for suspecting an association between pituitary prolactinomas and OC use, recent studies have failed to find an increased relative risk for prolactinomas in women using OCs for contraceptive purposes, although 1 study found an increased risk in women using OCs for cycle control. 1 study reported 11 pregnancies in 30 diabetic women in 15 months of IUD use; the high rate was attributed to abnormal patterns of mineral deposit on the IUD surface. The 11 pregnancies occurred with 5 Gravigardes, 5 Saf-T-Coils, and 1 Dalkon Shield. Other studies on the contrary have noted no difference in pregnancy rates among 103 diabetic women using Copper Ts or 118 diabetic women using Lippes loops. Combined OCs appear to reduce the incidence of rheumatoid arthritis by 1/2 among current OC users and to protect former users as well. Combined OCs aggravate lupus erythmatous but synthetic progestins alone are effective without aggravating the condition. It has recently been argued that low dose OCs are not contraindicated in cases of sickle cell disease and may even offer protection against thromboembolic vascular accidents for women with sickle cell anemia. Estimates of relative risk of pelvic infection among IUD users vary from 1.5 to 6.5, with the risk apparently greatest for women under 25. Recent studies have indicated that copper IUDs do not have the bactericidal power formerly attributed to them. Numerous in vitro studies and statistical comparisons of the effect of spermicides in vivo have demonstrated that local methods provide protection against sexually transmitted diseases. OCs may favor vaginal infection, but some recent studies have indicated that they offer protection against pelvic infections. The protective effect of the condom against sexually transmitted diseases is well known. It has been estimated that, relative to non-users of OCs, each 100,000 users will have 235 fewer cases of benign breast disease, 35 fewer of ovarian cysts, 320 fewer of iron deficiency anemia, 600 fewer of pelivc infection, 117 fewer of extrauterine pregnancy, 32 fewer of rheumatoid arthritis, 1 fewer of endometrial cancer, and 3 fewer of ovarian cancer.

It is uncertain whether the efforts made by modern woman to break away from her traditional position in the couple and in society will be crowned with success. The gynaecologist does not fail to consider in his field that woman's protest, on the one hand, and her affirmation, on the other hand, influence her genital physiology. Her inability to adapt herself may manifest itself in relatively specific disorders, whereas, on the contrary, her equilibrium will guarantee the harmonious functioning of her organs. This equilibrium is conditioned by a profound sense of her identity, based on a perfect integration of her body and her affective potential. If this sense is developed, she will approach the world around her with more or even unlimited security. The author has carefully examined a certain number of gynaecological situations and observed how the patient at one with herself is able to integrate her sex. This feeling of harmony provides an obstacle to the conviction of being at the mercy of a sort of evolutional fate from puberty to menopause. Even when her ailing body no longer corresponds to the definitions of health she adopts an attitude which shows that she accepts herself in all her femininity.