RESEARCH FINDINGS USING GUIDED
IMAGERY FOR
PREMENSTRUAL
SYNDROME
September, 2006
Definition
of the Problem
Premenstrual Syndrome (PMS) refers to a cyclic group of
symptoms, both physical and psychological, that can affect
a woman in the days or weeks prior to the monthly onset of
her period ("menses"). The pain that can accompany
menstruation is called dysmenorrhea.
Primary dysmenorrhea is the “normal” uterine contractions
that occur during menses; its exact cause is unknown, but
hormones probably play a primary role. Secondary
dysmenorrhea is the result of an underlying condition
(infection, inflammation, or other disorder).
Scope and Cost of the Problem
According to the American Academy of Obstetricians and
Gynecologists, up to 85% of women have one or more symptoms
of Premenstrual Syndrome. About 5-10% of women report being
debilitated by severe symptoms (ACOG, 2000).
This equates to
approximately 2.5 million American women. Some of the more
intrusive symptoms include pain, headache, tension, mood
swings, depression, and fatigue.
Absenteeism due to the severity of PMS and menstrual pain
is “underappreciated” (Harlow and Park, 1997) and is a
leading cause of absenteeism for women under thirty
(Daugherty, undated). One-third of women affected by
dymenorrhea have an average of 9.6 days of bedrest and lost
productivity annually (Kjerulff, Erickson, and Langenberg,
1996). A 2002 study estimated that heavy bleeding alone
contributed to a 6.9% reduction in annual employment (Cote,
Jacobs, and Cumming, 2002), while a 1984 study reported the
annual indirect costs of dysmenorrhea at $2 billion in lost
productivity, and 600 million lost work hours (Dawood,
1984).
Treatment
Dysmenorrhea and PMS are
usually treated with either over-the-counter or
prescription diuretics ("water pills" to reduce water
retention) and NSAIDS (for pain). Oral contraceptives or
prostaglandin inhibitors (both available only by
prescription) are treatments for primary dysmenorrhea.
Medications to regulate other hormone production are
sometimes used. Severe psychological symptoms often respond
to anti-depressants. All of these treatments vary in
effectiveness from woman to woman. Calcium/ magnesium
supplements are clinically proven effective. Lifestyle
modifications (diet, sleep, and exercise) are often
effective in relieving symptoms.
Mind-Body Therapies
A recent
review of the literature published in the
American
Journal of Obstetrics and Gynecology
confirmed that
women with PMS and PMDD widely use complementary and
alternative medicine, and that there is “substantial
evidence of efficacy” for mind-body approaches to these
conditions (Girman, Lee, and Kligler, 2003).
One such approach is Cognitive Behavioral Therapy. A 2002
study of 108 women showed that Cognitive Behavioral Therapy
was as effective as fluoxetine in the treatment of PMDD,
and that CBT was associated with better maintenance of
treatment effects than was the
prescriptive (Hunter, Ussher, et al,
2002).
Studies also support the use of the mind-body therapies
relaxation and guided imagery for PMS and menstrual pain.
In one study, women who participated in a regular
relaxation program reported a significant 58% improvement
in their severe premenstrual symptoms (Goodale, Domar, and
Benson, 1990).
Another study showed the
effectiveness of relaxation training, either alone or
combined with imagery, in reducing resting time for women
with spasms of cramping (Amodei, Nelson, et al, 1987). Not
only does relaxation help with menstrual pain and
discomfort, but it is also effective in reducing
absenteeism. These beneficial effects were long-lasting
(Quillen and Denney, 1982).
While mind-body interventions can positively affect
menstrual distress, they can also affect cycle rhythmicity.
In addition to significantly decreasing perceived distress
scores, women in a guided imagery study were also able to
lengthen their cycles (Groer and Ohnesorge,
1993).
Conclusion
Using guided
imagery to reduce the severity of PMS and menstrual pain
can lead to increased comfort and decreased absenteeism,
without the cost and potential undesirable side effects of
some medications.
REFERENCES
[no authors listed] ACOG Issues
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March 31, 2000. Qtd on: News Rx. Women’s Health Weekly. May
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