Tuesday, February 15, 2005

The Cost of PMS

Sorry for the lack of posting; real life, and all that. An encouraging observation from my offline activities. I was interviewed by a reporter from Organic Style magazine, who was working on a piece on PMS. One thing she mentioned she learned from my book, and something she found most useful, was the fact that women who use the Pill no longer menstruate, for as long as they use the Pill. [I was recently wondering if it's true that a majority of Pill users aren't familiar with menstrual suppression. The reporter opined that's true.]

It's great that readers are picking up on this information.

It's one thing to have a patient "trapped" in an examining room while you're trying to explain something. You can persist until you make sure she understands [or, until she's had enough and manages to extricate herself, and run away from all your hand-outs, and schematics. Yes, as hard to believe as that is, some women just don't find the minutia of reproductive organs or contraceptives as fascinating as I do.]. It's another thing to throw the information "out there" in the form of a book, and not know if the main points are getting across. [And you wonder why I have a blog; can you say instant feedback?]

Speaking of PMS, while Australians are considering a menstrual leave, researchers in the U.S. looked at a sample of regularly menstruating women aged 18-45 and estimated the cost of PMS:

A total of 29.6% ... of the participants were diagnosed with PMS. A PMS diagnosis was associated with an average annual increase of $59 in direct costs ... and $4333 in indirect costs [days of work missed and lost productivity at work] per patient ... compared with patients without PMS.

If we extrapolate from these results, we can get an idea of the magnitude of the problem. If about 1/3 of all the reproductive age women (60,201,000 women aged 15-44), or 18,060,300, are diagnosed with PMS, we have an average annual increase of $1,065,557,700 in direct costs, and $78,255,279,900 in indirect costs. Hm, either I need to update my calculator [I don't; I checked my numbers], or these are some impressive estimates.

What would be interesting to know is how many of the estimated 18,060,300 women diagnosed with PMS [about 2% to 9% suffer from PMDD] 1) contact their physician for treatment [?self-medicate], and 2) suffer in silence.

Unfortunately, for the first group, the news isn't that good. One survey revealed that, in a majority of cases, women sought help from multiple physicians for more than 5 years before a diagnosis of PMS was made. For the second group, it would be instructive to learn if the women a) don't know there are treatment options available, or b) they do know, but elect not to use them.

One more interesting number: [T]he average woman experiences 7-14 symptoms premenstrually every month, and ... this amounts to a staggering 1680 symptomatic days every decade!

And since I gave you all these numbers and projections about PMS, here's a good review article on the evaluation and treatment of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Since the author is a pharmacist, the article has a good Treatment section, covering:

Lifestyle modifications

Antidepressants (Sarafem)

Anxiolytics (Xanax)

Combination birth control pills


GnRH agonists (Lupron)




Nonsteroidal anti-inflammatory drugs (Ibuprofen)

Alternative Therapies: vitamin B6, calcium, magnesium, manganese, vitamin E, combination supplements, evening primrose oil, other herbal products.



At 4:48 PM, Anonymous Anonymous said...

What do you think about PMDD? From what I understand it was made up by Eli Lily to extend its patent on Prozac. Do you think PMS can be as bad as PMDD? Do you think it should be treated with Prozac/SSRIs?

At 9:23 PM, Anonymous Anonymous said...

As a PMDD sufferer, I don't think it was made up. I thought that what I went through right before and during my period was "normal", until I talked to many other women, including my mother, and suddenly came to the depressing realization that what I was I was going through every month, was not "normal". I am on an anti-depressant and I hate that - but at the same time, I can function, I can get out of bed and I can carry on a "normal" conversation with my husband.


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