PMS
Pre-Menstrual Syndrome
Over 150 years ago Dr. Ernst Von Feuchtersleben wrote, "The menses in sensitive women is almost always attended by mental uneasiness, irritability and sadness." PMS is not a new disease!
PMS (Pre-Menstrual Syndrome) is the complex of unwelcome physical, mental and emotional changes that occur before and during a menstrual period. The hormonal changes of the cycle cause biochemical alterations that give rise to a great variety of symptoms.
Many important questions about PMS remain unanswered:
- Exactly what causes it?
- Why is there so much variation from cycle to cycle?
- What determines which symptoms a woman will have?
- Why do some women have more problems than others?
- What is the best treatment?
Almost every woman notices physical, mental and/or emotional changes just before and during her menses. In a small minority these changes are positive. A woman might crave a more healthy diet, have more energy, increased interest in sex, a greater feeling of well-being or increased competitiveness. Unfortunately the overwhelming majority of women notice changes that make life worse instead of better. These fall into two broad categories.
Physical symptoms of PMS: Weight gain, bloating, water retention, constipation, diarrhea, cramps, acne, dizziness, faintness, cold sweats, nausea, vomiting, hot flashes, backache, headache, breast swelling and soreness, increased appetite, cravings for certain foods especially sweet or salty ones, outbreaks of genital herpes.
Mental, emotional and behavioral symptoms of PMS: fatigue, confusion, increased need for sleep, insomnia, poor judgement, loss of interest in usual activities, impaired coordination, nervous tension, forgetfulness, loneliness, tearfulness, irritability, depression, mood swings, feelings of being helpless or overwhelmed, loss of control, decreased motivation.
It's not surprising that these changes can cause problems in interpersonal relations. Being aware of the possible symptoms and working to modify them can limit the upset to your life. If PMS is severe it can cause major disruptions at home, work and school and in your social relationships.
The are almost as many treatments for PMS as there are symptoms. Consultation with your gynecologist is necessary to develop the optimum program for you. Treatment strategies might include a number of different approaches:
1. Exercise is the single most useful treatment. The best types are running, swimming, taking an aerobics class or using an exercise bicycle. The activity must be moderately intense and last for at least 30 minutes without a break. It's best to do this three times a week regularly and then increase it to daily just prior to your period.
2. Lower body weight is helpful even if you're only 10 or 20 pounds overweight. Fatty tissue in a woman's body produces female hormones. These add to those produced by your ovary and other glands and may increase any PMS symptom. Consult weight loss for assistance.
3. A diet with less sugar, less salt and more complex carbohydrates may be helpful. Complex carbohydrates are starches like rice, bread, pasta, potatoes, corn, peas and beans. Try eating small amounts every 3 hours. That's 6 small meals a day!
4. Calcium and magnesium supplements help some women. Calcium will also help you build strong bones to guard against osteoporosis later in life.
5. Vitamin E (1000 units per day) often reduces breast tenderness.
6. Unless you have an excellent diet you should take a multi-vitamin every day. The ingredients are usually the same so the cheapest is probably the best choice.
7. Avoid alcohol and caffeine.
8. NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen and naproxen are useful for pain relief. They are more effective if taken as soon as the headache or cramps begin. Don't wait until the discomfort is severe.
9. Hormonal medications may be tried. If women with PMS take birth control pills, 1/3 get better, 1/3 get worse and 1/3 have no change. Depo-Provera helps many women but if you don't like it you're stuck with it for 3 months. Danazol (Danocrine) is worth a try in some cases.
10. Diuretics (water pills) generally do not help very much. If used they should contain a potassium sparing ingredient like spironolactone.
11. Tranquilizers can be useful in some situations. One of the benzodiazepine class like alprazolam (Xanax) would be reasonable to try. Buspirone (Buspar) can also be effective.
12. The newest and possibly best treatment is the use of GnRHa (gonadotropin-releasing hormone agonists) with low dose estrogen/progesterone added back. This is very expensive and would only be used in severe cases.