ABSTRACT
Objective: To retrospectively evaluate the
efficacy of local uterine antibiotic and anti-inflammatory injections combined
with cryotherapy for the treatment of severe Premenstrual Syndrome (PMS) and
Premenstrual Dysphoric Disorder (PMDD). To validate the hypothesis of a uterine
infectious/inflammatory etiology of PMS/PMDD. Methods: Clinical files of 161
women sequentially treated from September 1995 to April 2005, were collected
for study. A subset of 148 patients (mean: 36.7 ± 7.8 years, range: 20.1 - 53.8
years) were eligible for statistical analysis. The ten most relevant PMS
symptoms, namely depression, irritability, anxiety, fatigue, headache, edema,
breast tenderness, abdominal bloating, pelvic pain and dysmenorrhea, were
self-rated before and three menstrual cycles after treatment, using a 0 to 5
scale. The treatment consisted of cervical stromal antibiotic/anti-inflammatory
injections combined with intracervical cryotherapy. Scores were compared using
non-parametric tests for matched samples. Results: Before treatment, mean
severity scores for the 10 symptoms were 3.97 ± 1.17, 4.26 ± 0.88, 3.41 ± 1.23,
3.91 ± 0.94, 3.35 ± 1.71, 2.28 ± 1.69, 2.13 ± 1.63, 4.51 ± 0.63, 2.28 ± 1.30, and
2.28 ± 1.88, respectively. Mean values after treatment were 0.54 ± 0.91, 0.51 ±
0.91, 0.32 ± 0.70, 0.42 ± 0.74, 0.43 ± 0.96, 0.22 ± 0.53, 0.39 ± 0.73, 1.01 ±
0.94, 0.28 ± 0.69, and 0.44 ± 0.92. All tests were statistically significant (p
< 0.01). Conclusion: Both PMS physical and psycho-affective symptoms respond
to local anti-inflammatory and antibiotic treatment of the uterus, showing a
stable improvement after the treatment has ended. The results of this study
suggest that the clinical pattern of PMS can be explained as an inflammatory
mediated response to uterine infectious or traumatic insults. Further evidence
is urgently needed in order to validate this innovative approach for widespread
use in severe PMS/ PMDD cases.