Carol E. Watkins, MD

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Premenstrual Syndrome (PMS) refers to  uncomfortable physical and mental symptoms that occur before the onset  of the woman’s menstrual period. Estimates of affected women  range from 40 to 80%. About 5% of women experience symptoms that cause  them severe impairment. PMS may start at any time during the years that a  woman menstruates. The peak occurrence is in the 20s and 30s. Once PMS  begins, the symptoms often continue until menopause. 

About 150 separate symptoms have been documented, but it is unlikely that any one woman will have all of them. The symptoms can be divided into three general categories.

Exacerbation of existing psychiatric condition 


         
         Lifestyle Changes: Many women find that healthy lifestyle  changes decrease symptoms of PMS. Exercise, three to five days per  week, improves mood, and increases physical tone. Women who exercise  regularly have fewer PMS symptoms. Eating less salt may minimize  bloating and swelling. Also helpful is a healthy diet, rich in complex  carbohydrates and low in simple sugar. Decreasing caffeine and alcohol  intake may help irritability and mood swings. Relaxation techniques,  such as meditation or yoga, decrease physical discomfort and stress. 

Self Knowledge: A woman with mild PMS, are able to accept and  adjust to her monthly changes in energy and mood. Although parts of the  experience are unpleasant, she discovers that it helps her to view  things from a different perspective. If she is impulsive or irritable  before her menses, she may decide to defer important decisions for a few  days. If she feels angry at a friend, she may write down the anger. If,  after a few days, it still bothers her, she then responds to the anger.  Some women learn this on their own. Others may seek counseling to help  reduce stress and to learn ways to actively cope with the PMS. 

Social Support: A supportive spouse or roommate can be a  great help during low energy days or periods of irritability. Some women  can take turns helping each other during vulnerable times. However,  women who live or work closely together often go into synch: they have  their menses at the same time. Depending on the situation, this can  either be a support or a difficult time for the entire group. 

Vitamins and Minerals: There is some evidence that Calcium  may decrease many PMS symptoms.  Moderate doses of Magnesium and Vitamin  E may also be helpful. Controlled trials have failed to show nay  benefit from high dose Vitamin B6. Additionally, high doses of B6 can  cause peripheral nerve damage. 

Treating Physical Symptoms: If lifestyle and dietary changes  are not effective, there are other treatments. Diuretics help reduce  fluid buildup and decrease bloating. Some women find that oral  contraceptives decrease symptoms of PMS. This varies, depending on the  dosage and mix of hormones in the particular pill. Non-steroidal  Anti-inflammatory Drugs  such as Ibuprofen, are helpful for  PMS-associated pain. 

Mood Changes: Marked mood changes are called Premenstrual  Dysphoric Disorder. (PMDD) The symptoms of PMDD resemble major  depression. A woman with PMDD has her mood swings only in the one to two  weeks before her menses. When we suspect PMDD, we often ask the woman  to chart her moods for three months. This helps determine whether the  mood shifts are confined to the premenstrual days. If depression or  other mood shifts also occur in other phases of the cycle, we treat it  as any depression, anxiety or bipolar disorder, using psychotherapy or  medication.  If charting reveals that depression occurs only before  menses, we can choose to treat with medication all month or we may  decide to use medication only during the days before menses. The woman  should be an active participant in making this decision. Full-cycle  treatment is easier to remember. It does not require the same degree of  charting and calendar watching. However, if the woman experiences  medication side effects, or simply wants to minimize her medication use,  she can take an antidepressant during the 10-14 days before her menses.  The SSRIs (Prozac, Paxil, Zoloft and others) are the first-line  antidepressants for premenstrual depression or irritability. They seem  to work more rapidly for PMS mood symptoms than for regular major  depression. If a woman has significant manic symptoms before her menses,  she may need to take a mood stabilizer such as Lithium or Depakote  during her entire cycle. 

Some women find that when the most severe symptoms, mood, or  physical symptoms, are addressed; the other symptoms are less intense.  Thus, a woman who is successfully treated for premenstrual depression  may experience fewer physical symptoms. Other women need active  treatment for both kinds of symptoms. 

Premenstrual-type symptoms may temporarily become worse in the perimenopausal period (the years just before menstruation ceases.) However, true menopause often brings the end of premenstrual symptoms.

Articles

Premenstrual Syndrome (PMS) refers to uncomfortable physical and mental symptoms that occur before the onset of the woman’s menstrual period. Estimates of affected women range from 40 to 80%.

Author | Carol E. Watkins, MD

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