Ginkgo Ginkgo (Ginkgo biloba) traditionally was used to relieve breast tenderness and discomfort, improve concentration, and enhance sexual function. Its vascular effects, particularly with regard to dementia and peripheral vascular disease, were studied. One large study examined the effectiveness of ginkgo in the treatment of women with PMS and found that after two cycles with treatment, breast symptoms were significantly improved in the ginkgo group. The effectiveness in terms of concentration or libido was not examined (40). In doses ranging from 60 to 240 mg of standardized extract per day, ginkgo showed some clinical efficacy in the treatment of breast pain, tenderness, and ﬂuid retention. In at least one study, ginkgo was effective in the relief of symptoms related to emotional distress (41). Ginkgo is promoted as an agent that can increase libido, but the methodology of these studies was criticized, and further studies are required to better define the botanical’s role in these areas. Side effects include gastrointestinal upset and headache. High doses can cause nausea, vomiting, diarrhea, restlessness, or insomnia. Ginkgo has anticoagulant activity, and care must be taken when used with anti-inﬂammatory drugs and with warfarin. The underlying mechanism of action is believed to be dilation of vessels and increased blood ﬂow.
Other products that are used to treat symptoms of PMS and PMDD but are not recommended are listed in Table 13.8.
Although dysmenorrhea is managed more effectively than PMS and PMDD with conventional approaches, treatment still has a failure rate of approximately 20% to 25%, and many patients seek
Table 13.8 Other Products Often Used to Treat Symptoms of PMS And PMDD (Not Recommended)
Tryptophan, an amino acid that is a precursor of serotonin, has been shown in several trials to improve the symptoms of PMS and PMDD. Impurities in one product made in Japan have been associated with the development of eosinophilia–myalgia syndrome (EMS), which can be fatal. It is unclear if all the cases were related to impurities or if some were related simply to the active ingredients. Until this is clearly understood, tryptophan should be avoided.
Dehydroepiandrosterone (DHEA), a hormone secreted by the adrenal glands and often used for depression, has not been shown to be of benefit in PMS/PMDD.
Melatonin, a hormone that regulates sleep–wake cycles and often is used to prevent jet lag, has been used for the treatment of PMS. There is no evidence of efficacy, and it can worsen depression in some patients.
Black cohosh (Cimicifuga racemosa) has been well studied in the treatment of menopausal symptoms, but it has not been studied in the treatment of PMS/PMDD. Although it may prove to be beneficial, data are needed.
Evening primrose oil is frequently used for PMS, but with the exception of cyclic mastalgia, research has failed to show benefit beyond placebo.
Dong quai is an oriental herb often used in combination with other herbs for the treatment of menstrual disorders and menopausal symptoms. Its effectiveness has not been researched.
Kava has been used to treat anxiety and irritability, and several studies have documented its effectiveness. It has, however, been associated with hepatotoxicity, even necessitating liver transplant. It is unclear whether this effect was related to drug or alcohol interactions, contaminants, or the kava itself.
PMS, premenstrual syndrome; PMDD, premenstrual dysphoric disorder.
Table 13.9 Findings on Alternative Treatments
Magnesium Three small trials were included that compared magnesium with placebo. Overall, magnesium was more effective than placebo for pain relief, and the need for additional medication was lessened. There was no significant difference in the number of adverse effects experienced.