Premenstrual Syndrome (PMS)

Source: Adapted from Knowing Your Options: The Definitive Guide to Choosing The Medical Treatments, Reader’s

What is premenstrual syndrome (PMS)?

Every month, you feel crabby, crave that whole box of chocolates, and suffer from breast tenderness, bloating, cramps, weight gain, or headaches—and sometimes all at once. The discomfort may last from a few hours to several days. Or it may begin a week or two before your period and stop abruptly when the bleeding starts. Because premenstrual syndrome can elicit some 150 different symptoms, there’s really no typical case. While most women find it annoying rather than disabling, an estimated 3% to 8% have truly severe symptoms, suffering from a variety of physical problems as well as serious depression—a condition called premenstrual dysphoric disorder, or PMDD.

Who is at risk for premenstrual syndrome?

Research remains inconclusive about the cause of PMS. Many experts blame an imbalance of female hormones estrogen and progesterone, which may interfere with brain chemicals that control mood and pain. Others suspect low levels of serotonin, a brain chemical associated with emotional well-being. Additional culprits may include nutritional deficiencies, fluid and sodium retention, low blood sugar, and a heightened stress response. No one theory offers a satisfactory explanation for all women. There’s a natural limit to PMS: Symptoms, which usually strike in the mid-20s, generally subside after age 35. They disappear completely with menopause.

Treatment for premenstrual syndrome

Many women accept PMS as an unfortunate fact of life: A 1999 survey found that those who suffered most were the least likely to seek treatment, believing nothing could be done. Yet PMS is very treatable. If your symptoms are on the mild side, adopting a healthier lifestyle may be all it takes to make you feel better. You’ll likely require some pharmaceutical help for moderate or severe PMS or PMDD. Once you find the right therapy, you should be virtually free of symptoms after three menstrual cycles.

Medications for premenstrual syndrome

For mild PMS aches and pains, OTC pain relievers such as aspirin, ibuprofen (Advil), or naproxen (Aleve) often work fine. You can also try a specialized product such as Midol, Pamprin, or Premsyn, which contains acetaminophen along with a diuretic and/or antihistamine. For severe breast pain, ask your doctor about a prescription dopamine agonist called bromocriptine (Ergoset, Parlodel). It reduces the levels of the hormone prolactin, which controls lactational changes in your body, but it can sometimes cause side effects.

If you have bloating that doesn’t respond to dietary measures, a prescription diuretic may help eliminate water and sodium. One of the best is spironolactone (Aldactone). Unlike other diuretics, it doesn’t deplete potassium, which can lead to heart rhythm disturbances. If hormonal fluctuations are your problem, you may be given an oral contraceptive that contains both progestins (natural or synthetic forms of progesterone) and estrogen. A new combination contraceptive called Yasmin contains both estrogen and drospirenone, a substance similar to natural progesterone. It regulates mood swings and may relieve the severe emotional distress of PMDD.

Also useful are antidepressants called selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft) and paroxetine (Paxil). They increase mood-elevating serotonin. Fluoxetine (Sarafem) was the first SSRI approved by the FDA for treating PMDD as well as PMS. Sarafem is taken right before your period (it’s actually the same drug as Prozac, sold under a different name).

Lifestyle Changes

One easy way to begin controlling your PMS symptoms is to adopt a low-fat, high-fibre eating program light on junk food and heavy on fresh produce, whole grains, and legumes. Whole foods tend to be high in complex carbohydrates, which relieve irritability by raising blood levels of tryptophan. This amino acid converts to the mood-elevating hormone serotonin. Munching on fresh fruits and whole-grain breads may also curb an unhealthy appetite for sugary treats or salty snacks—foods that often lead to water retention or a bad mood. You’ll also need to beware of caffeine. While coffee, tea, and colas can increase urination, they can also increase irritability and sleep problems.

In addition to diet, regular exercise also helps reduce many PMS symptoms. At the very least, aim for 30 minutes of aerobic exercise—walking, swimming, cycling—three times a week. Try some stress-reduction techniques—yoga, guided imagery, meditation—to help you relax and cope with any emotional symptoms. And don’t forget the ultimate in relaxation: sleep.

Alternative Therapies for Premenstrual Syndrome

In addition to making lifestyle changes, many women with PMS have had success using these natural products, as well as the herbal remedies:

• Calcium. In a study from Columbia University, PMS patients who took 1,200 mg of supplemental calcium daily for three months reported a 48% reduction in such PMS symptoms as breast tenderness, bloating, headaches, and moodiness.
• Magnesium. During the last two weeks of your menstrual cycle, magnesium levels fall. That may increase water retention, headaches, and irritability. Try taking 250 mg of this mineral twice a day, every day, with food.
• Vitamin B6. Some studies find B6 works for PMS headaches, fatigue, depression, and breast pain; others don’t. Just 50 mg twice a day can be effective. Avoid high doses: 200 mg or more for an extended period can cause nerve damage and irritability.
• Natural progesterone cream. This is synthesized progesterone, a mild sedative. Look for a 2% progesterone cream, such as Pro-Gest, with at least 400 mg of progesterone per ounce. Apply about H teaspoon twice a day, following label directions, during the two weeks before your period.

Herbal Remedies for PMS

If you want to use herbs for PMS symptoms, allow three months for noticeable benefits. Be sure to tell your doctor.

• Chasteberry (vitex) helps normalize the ratio of progesterone and estrogen, providing relief for irritability, depression, and bloating. Avoid using it with oral contraceptives or bromo-criptine.
• Evening primrose oil contains gamma-linolenic acid (GLA), an essential fatty acid (EFA), which reduces cramping by interfering with production of inflammatory hormone-like chemicals called prostaglandins. It may relieve bloating, breast tenderness, and irritability.
• St. John’s wort, used for mild to moderate depression, appears to boost levels of serotonin, which controls moods and emotions. Avoid using it if you’re on antidepressants or oral contraceptives.
• PMS herbal combinations provide a number of helpful herbs in one convenient capsule. Some products also contain the vitamins C, E, and B, plus magnesium.

Questions for Your Doctor

• If I’m depressed only some of the time, why do I need an antidepressant?
• Could I be suffering from seasonal affective disorder?
• Will PMS or any treatment for it, make it harder for me to conceive?
• Do you think a special PMS clinic or support group might help me?

Living with Premenstrual Syndrome

If you’re living with PMS, here are a few quick tips to help you take control:

• Keep a symptoms diary for at least a few months. Chart how you feel and when, as well as dates when your period starts and ends. This will show the cycle of your PMS symptoms and help your doctor eliminate other possible causes. Problems are often due to another ailment, such as pain linked to menstruation (dysmenorrhea) or seasonal affective disorder (SAD).
• Don’t eat meat. A 2000 study found that women who ate a low-fat vegetarian diet for two menstrual cycles had less pain and bloating than meat eaters. Try replacing red meat with salmon, tuna, or other oily fish rich in the omega-3 fatty acids that can help relieve menstrual cramps and possibly related depression.
• Try cognitive-behavioral therapy. If you suffer from depression or feelings of hopelessness due to PMS or PMDD, a psychotherapist can help you master techniques for solving problems, managing obstacles, and restructuring priorities. The therapist will give you new ways of thinking about your condition so you can overcome pessimistic thoughts and regain a sense of control.
• Be wary of certain PMS clinics. If a clinic insists on expensive preliminary lab work, charges high fees payable in advance, pushes one treatment for all patients, or offers a fast diagnosis and quick fix, look out. Choose one that’s run by a physician you trust and that tailors treatment specifically to you.