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Understanding PMS

June 10, 2008 - 7:30am
 
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Understanding PMS

Image for pms article For five days each month, June Summers, an active 42-year-old business manager, feels like a different person. She becomes high-strung and impatient, snaps at her partner, and doesn't trust herself to make important decisions. Physically, she feels terrible. She has outrageous salt cravings and gains at least five pounds over the five days. At first, she couldn't understand why she felt so different. But when she noted these changes on her calendar for several months, she realized she had some classic symptoms of premenstrual syndrome (PMS).

Knowing when her symptoms occur and that they will go away in a few days has helped June learn to live successfully with her PMS. When her symptoms come on, she takes calcium, avoids coffee, and goes on long walks to relax. If she feels really bloated, she takes a low-dose diuretic. But most importantly, she does not plan business meetings or other stressful activities during the last two days before her period. During those days, she tells the people close to her that she is premenstrual so they can provide support and understanding.

What Is PMS?

PMS is a group of symptoms that occur 1–2 weeks before the start of a woman's period. They usually disappear when menstrual bleeding starts. Within about two days most women feel better. If these symptoms occur in earlier weeks of the woman’s cycle, PMS can not be the only diagnosis. PMS symptoms can occur at any interval between puberty and menopause but are more likely to become a problem beginning in the mid-30s.

Most women experience some changes as their period approaches. A woman is considered to have PMS when these changes—physical and/or emotional—become uncomfortable and cause problems in her life. Symptoms can range from mild to severe, and sometimes wreak havoc in relationships. Fortunately, some symptoms of PMS can be treated.

Although up to 85% of menstruating women report one or more premenstrual symptoms, only 5% to 10% have symptoms that are severe enough to cause the significant lifestyle impairment that is associated with the diagnosis of PMS. Researchers have not yet determined the cause of PMS. However, most think it is related to the interaction between the central nervous system and hormonal changes during a woman's menstrual cycle. PMS occurs in women with regular (hence, ovulatory) menstrual cycles.

What Are the Symptoms of PMS?

Many different symptoms can be part of PMS. They may vary in severity from one month to another, therefore the symptoms are usually charted and reviewed over 2–3 menstrual cycles. Every woman has her own individualized set of symptoms. Although there are many symptoms commonly associated with PMS, the medical diagnosis of this condition is based on the presence of at least one affective or "mood" symptom and one somatic or "physical" symptom during the five days before menses (called the luteal phase). In order to meet the diagnostic criteria of the American Psychiatric Association, at least one of each type of symptom must be present in three consecutive cycles. Listed below are the official diagnostic criteria:

Affective symptoms:

  • Depression
  • Angry outbursts
  • Irritability
  • Anxiety
  • Confusion
  • Social withdrawal

Somatic symptoms:

  • Breast tenderness
  • Abdominal bloating
  • Headache
  • Swelling of the extremities

How Do I Know If I Have PMS?

There are no laboratory tests that can diagnose PMS. However, your physician may recommend tests to rule out other conditions, such as thyroid disorders, which can sometimes cause similar symptoms. It is often difficult to distinguish PMS from other physical or emotional problems. In addition, some underlying medical conditions will have more noticeable symptoms during a woman's menstrual cycle. Examples include irritable bowel syndrome, migraine headaches, and chronic fatigue syndrome.

Since the timing of PMS symptoms is its most distinguishing feature, keeping a calendar of your symptoms and exactly when they occur is the most important factor in diagnosis. This record helps show any patterns in your symptoms. Your healthcare provider can determine whether you have PMS based on your symptoms calendar along with a physical exam and health history.

Is There a Treatment?

There are many kinds of treatment used to relieve PMS symptoms. Many have not been scientifically proven to be effective. However, most researchers and healthcare providers agree that changes in lifestyle—diet, exercise, and stress management—should be the first approach. The following are some of the most common suggestions:

  • Avoid sugar, salt, caffeine, alcohol, red meat, and other fatty foods.
  • Eat 4–6 small meals a day instead of three larger ones. Do not skip meals.
  • Exercise 20–30 minutes at least three times a week. Walking is helpful. Aerobic exercise, such as jogging, bicycling, or swimming, may provide even more relief.
  • Try relaxation techniques such as meditation, deep breathing, or yoga.
  • Try not to plan stressful activities or events during the time when your symptoms are worst.

Over-the-counter medicines, such as Advil and Motrin, may be helpful in relieving some of the physical symptoms of PMS, including headaches, breast tenderness, and cramps. There is some supporting evidence for a few non-drug treatments, especially calcium and chasteberry, but also vitamin E, multivitamin/multimineral supplements, and magnesium.

There are several over-the-counter preparations that tout their ability to prevent or minimize the symptoms of PMS. At least two of these are powders that are mixed with water, the main ingredients of which are carbohydrate and flavoring. While not harmful, they are expensive.

If lifestyle changes and other treatments do not help after a few months, your healthcare provider may recommend a prescription medication. Diuretics were commonly prescribed in the past, but most have been proven to be ineffective or to have unacceptable side effects. Birth control pills seem to help relieve physical symptoms in many women, but cause more PMS symptoms in others.

In July of 2000, the FDA approved the use of fluoxetine, marketed as Sarafem, for the treatment of severe premenstrual syndrome. Fluoxetine, the same chemical also known as Prozac, is a selective serotonin reuptake inhibitor (SSRI). It may be that severe premenstrual symptoms are the result of abnormal interactions between sex steroids (hormones) and the serotonergic system in the brain. Sarafem's action on this system is theorized to moderate these interactions and decrease the associated PMS symptoms.

The use of anti-anxiety medicines, such as Xanax, is controversial; some studies have shown beneficial effects, whereas others have not, and sedation is a bothersome side effect for many patients.

Progesterone was used widely until recently, although there was no research proving it effective. Doctors are now more likely to prescribe the scientifically proven antidepressants and anti-anxiety medications.

What Else Can You Do?

Learn as much as possible about PMS to help you gain more control over your symptoms. Ask your family, friends, and partner to provide support. Consider joining a PMS support group to share experiences with other women who have similar problems. If your symptoms are creating major difficulties in your life, a counselor or psychotherapist may be able to help you cope more effectively.

Until recently, women were told by the medical profession that PMS was "a part of their nature" and something they just had to live with. PMS is now understood as a medical condition, and treatments are available. So don't suffer in silence—seek help.

Suggestions for Partners

When your partner's PMS symptoms are at their worst, she may seem like a different person. You may feel confused, angry, or sad about the changes she goes through and the effects on your relationship. Here are some tips to help you cope:

  • Understand that PMS is a real medical disorder and that your partner is also having a hard time dealing with the physical and emotional changes she's experiencing.
  • Talk with your partner about how both of you are feeling.
  • Try to not take her actions personally.
  • Be patient and empathetic. Tell your partner you want to help her.
  • Show interest and support by learning more about PMS and encouraging your partner with any necessary lifestyle changes.
  • When her symptoms come on, provide some extra help with things such as household chores and child care.
  • Take care of yourself, too. Your partner's PMS can also be stressful for you.

RESOURCES

American College of Obstetrics and Gynecology
http://www.acog.org/

National Women's Health Information Center
http://www.4women.gov/

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://sogc.medical.org/

Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm

References

American College of Obstetricians and Gynecologists. Available at: http://www.acog.org/.



Last reviewed March 2008 by Ganson Purcell Jr., MD, FACOG, FACPE

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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