Dealing with the symptoms of Premenstrual Syndrome

Premenstrual Syndrome (PMS) is a poorly understood disorder that affects women. The most recent research supports the notion that women with PMS have an abnormal response to normal levels of the hormones estrogen and progesterone. Levels of these hormones fluctuate throughout the menstrual cycle resulting in the appearance and disappearance of symptoms.

Symptoms of PMS can range from mild to severe; they can be mildly annoying to completely disabling. Close to 100 symptoms have been ascribed to PMS. The most common include moodiness, anger, anxiety, irritability, depression, decreased interest in normal activities, tiredness, difficulty concentrating, appetite changes and sleep disorders. Physical symptoms include breast tenderness, headaches, swelling, bloating, generalized aches and pains and weight gain. Some women have predominantly physical symptoms whereas others experience more emotional upheaval. All of us have experienced one (if not all!) of these symptoms at one time or another. To attribute them to PMS a cyclical pattern must be demonstrated. This means that the symptoms start to appear in the last 7-10 days of the menstrual cycle then go away shortly after menstrual bleeding starts.

Many medical conditions can result in the symptoms experienced by women with PMS. There are no laboratory tests to diagnose PMS although physicians may recommend tests to exclude other medical illnesses. To help your doctor make an accurate diagnosis, a symptom calendar is essential. I recommend my patients pick the symptoms that bother them the most and keep track of them in a calendar for a few months. The calendar is then reviewed. If PMS is the diagnosis, a clear pattern will emerge. This is invaluable in guiding treatment. It makes no sense to treat the wrong condition!!

Treating PMS can be quite challenging. However some simple remedies exist. Exercise, even walking 30 minutes a day, can be helpful. Calcium supplementation (1000mg daily) has also been shown to decrease PMS symptoms. Cutting back on salt can alleviate some swelling and bloating. Controlling excessive sugar and caffeine intake can also be helpful. Medical therapies are generally directed at specific symptoms, which is another area that makes the symptom diaries useful. Birth control pills will help some women, but will make symptoms worse in others. Anti depressants such as Prozac and Zoloft have been shown to significantly reduce the mood symptoms attributable to PMS. These can be taken all month or only during the symptomatic days. Mild diuretics can be used for swelling and non-steroidal anti-inflammatory drugs are useful for generalized muscle and joint pain.

If you think you may have PMS, keep track of your symptoms for a few months before assuming this is the cause. If you are feeling a little "blue" before your period, don’t forget the healing powers of exercise and a little bit of pampering!! If PMS symptoms are severe, remember that remedies may be available.