Mind–Body Interventions Relaxation techniques showed some very promising results for women with PMS/PMDD. One study examined the effect of the relaxation response for 15 minutes, twice a day, for 3 months, compared with women who read for the same amount of time, and women who charted their symptoms. Of women in the relaxation response group, 58% experienced improvement in their symptoms, compared with 27% for the reading group, and 17% for the charting group (46). Given that there are many other health benefits to the relaxation response, with no cost and no risk, it is a good technique to recommend to patients. Cognitive-behavioral therapy (CBT) and group therapy were of benefit in several small studies. In one study, CBT was effective in reducing psychological and somatic symptoms and impairment of functioning when compared to controls. In two additional studies, the authors found that CBT reduced PMS symptoms compared to the control group (47).
Oriental medicine and acupuncture were used traditionally for thousands of years for myriad menstrual symptoms, PMS and PMDD among them. The effectiveness in this domain is not well studied. In one small study (n = 35), there was a 78% reduction in PMS symptoms in the acupuncture arm compared to 6% in the placebo arm (48). There were studies showing the effectiveness of acupuncture in the treatment of mild depression and generalized anxiety, although not all results were positive. There was a Cochrane review on the use of Chinese herbal medicine on PMS, and one on dysmenorrheal. In the review on PMS, the efficacy of Chinese herbal preparations, a randomized controlled trial of Jingqianping showed significant reductions in eliminations of symptoms (49).
There was one small but methodologically sound trial of acupuncture in the treatment of primary dysmenorrhea. This trial followed 43 women for 1 year and showed significant effectiveness of acupuncture when compared with placebo (91% of women showed improvement, compared with 10% to 36%, 18%, and 10% in the other groups) (23). In a study that randomized 201 patients, acupuncture improved dysmenorrheal and quality of life compared to usual care (50). In addition, there is some preliminary evidence that acupressure can be an effective, cost-free, and safe therapy for menstrual pain and anxiety. The study taught patients to self-administer 20 minutes of acupressure on Sanyinjian (SP6), which is an acupressure point located above the ankle. In a review on Chinese herbal presentations and their effectiveness on dysmenorrhea, 39 randomized controlled trials were included, involving 3,475 women. Chinese herbal medicine resulted in pain relief, and a decrease in overall symptoms and use of additional medications when compared to the use of pharmaceutical drugs. Individualized Chinese formulations resulted in significant improvement when compared to Chinese health products. Chinese herbal medicine produced better pain relief than acupuncture (51). More research is needed, but this is a promising and safe modality, and if a woman is fully informed and interested in pursing these approaches and has access to a qualified provider, it is appropriate to support.
The use of homeopathy in the treatment of PMS and PMDD is not well studied, and neither is its effectiveness in the treatment of related disorders such as depression or anxiety. One study did claim positive results but was fairly weak in design and in showing improvement (46). In one small but well-done study on individualized homeopathic remedies, 90% of patients had at least 30% improvement in their symptoms, compared to 37.5% having that degree of improvement in the placebo arm (47).
Mind–Body Interventions Mind–body approaches are of particular interest in the infertility patient. The treatments for infertility stress inducing, and increased stress is associated with decreased fertility (and increased risk of such things as gestational diabetes, preterm labor and delivery, and prolonged labor).