PREMENSTRUAL SYNDROME: WHAT YOU NEED TO KNOW

PPremenstrual syndrome (PMS) is a condition familiar to many women. Also known as ovarian cycle syndrome or premenstrual tension, it’s defined as a set of symptoms (e.g., moodiness, bloating, and breast tenderness) that comes on a few days before the start of a menstrual period. Unfortunately, PMS is poorly understood.

Different women will experience different PMS symptoms, and not every woman experiences PMS. For some women, PMS may cause major discomfort and even disrupt normal activities. Some are totally unaffected and feel perfectly fine during the days leading up to menstruation.

Other women may have a more severe form of PMS called premenstrual dysphoric disorder (PMDD). Women with this form of PMS may suffer severe depression, anger, or low self-esteem along with other symptoms.

Most women, over 90%, say they get some premenstrual symptoms, such as bloating, headaches, and moodiness.For some women, these symptoms may be so severe that they miss work or school, but other women are not bothered by milder symptoms. On average, women in their 30s are most likely to have PMS. Your doctor can help you find ways to relieve your symptoms.

CAUSES

Women’s menstrual cycles are controlled by a complex interaction of female hormones. These hormones help initiate menstruation during puberty, determine the rhythm and length of menstrual periods during childbearing years, and signal the end of menstruation at menopause. Hormonal control of menstruation involves the brain, pituitary gland, and ovaries.

The exact cause of PMS is unknown. It’s thought to be related to changes in the level of specific hormones. A few studies suggest that PMS symptoms are linked to premenstrual fluctuations in a brain chemical called serotonin and increased sensitivity to the hormone progesterone.

Other studies suggest that the hormone estrogen causes fluid retention, which probably explains the temporary weight gain, breast tenderness, and bloating experienced by many women with PMS. Recent research suggests that women with PMS may metabolize progesterone differently. Other hormonal and metabolic changes may also be involved, but further research is needed.

Other possible factors that may be associated with PMS symptoms include:

  • lack of certain vitamins and minerals
  • eating a diet that is high in salty foods
  • drinking alcohol or caffeine

SYMPTOMS AND COMPLICATIONS

If you suffer from PMS, you may experience different types of symptoms than your mother, your sister, or a female friend. Even if your symptoms are the same as someone else’s, you may experience them more or less intensely. Your symptoms may vary from menstrual period to menstrual period and may change over the years. For some women, symptoms are intense but short-lived. Other women have to interrupt their normal routines because of the symptoms they experience.

Symptoms can last anywhere from a few hours to 2 weeks before the start of a menstrual period. They usually start to go away when your period begins. In women close to menopause, symptoms may continue through and after a menstrual period. Some women go on to have painful periods after experiencing PMS. Teenage girls, for example, often have very painful periods after PMS, but this trend usually disappears as they get older.

PMS symptoms can be grouped into three categories:

Physical changes

  • Backaches
  • Bloating due to fluid retention
  • Breast tenderness, fullness, and pain
  • Changes in appetite (includes cravings for certain foods like chocolate)
  • Constipation or diarrhoea
  • Difficulty falling asleep
  • Dizziness
  • Feeling of heaviness or pressure in the pelvis
  • Headaches or migraines
  • Hot flashes
  • Joint pain and swelling
  • Lack of energy
  • Nausea and vomiting
  • Severe fatigue
  • Skin problems such as acne or itching
  • Temporary weight gain
  • Worsening of existing allergies

Mood changes

  • Agitation
  • Anger
  • Depression
  • Feeling sad, hopeless, or overwhelmed
  • Irritability
  • Mood swings
  • Nervousness

Mental changes

  • Confusion
  • Difficulty concentrating
  • Memory loss or forgetfulness

Complications usually involve existing medical conditions that are made worse by PMS. Allergies or eye problems may be more severe, and women who have epilepsy may have more seizures than usual. Women who have lupus or rheumatoid arthritis may experience flare-ups during this time.

Treatment

Many premenstrual syndrome (PMS) symptoms improve with treatment. Treatment options range from medication therapy to birth control pills to diet modification, including vitamin and mineral supplementation, herbal medicines and exercise.

Antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) are typically recommended to women with severe mood-related symptoms such as anxiety, depression or mood swings.

ARE THERE MEDICATIONS THAT MIGHT HELP?

If your symptoms don’t improve with a few nutrition and lifestyle changes, talk with your health care provider. He/she may be able to prescribe medicine that will help lessen or get rid of your discomforts.

There are many different medicines that are currently used to treat PMS symptoms. The most commonly prescribed are oral contraceptives (birth control pills) which prevent ovulation and keep hormone levels even.

Most pills (particularly those that are low in progestin or contain drospirenone) can improve symptoms. Sometimes symptoms can improve even more if the pill is taken continuously (one active pill every day and no placebo pills).

Other medications include ibuprofen or naproxen sodium that can help to relieve lower back discomfort and headaches and mild diuretics such as Spironolactone to lessen bloating and mood changes.

If depression is a significant issue, your health care provider may prescribe antidepressants such as Fluoxetine, Sertraline, or other SSRI medicines either for the 7 days before your period or daily.

In addition, there’s some evidence that some nutritional supplements such as vitamin E, magnesium and vitamin B-6 may help ease symptoms of PMS. Discuss these and other strategies with your health care professional before taking any dietary supplement.

There is no single treatment that works well for every woman who experiences PMS. Typically, it’s wise to try the most conservative treatment options first, which include lifestyle changes such as modifying your diet and exercising more. Discuss your symptoms with your health care professional if strategies you’ve tried don’t work, so he or she can recommend other treatment options.

PREVENTION

Can premenstrual syndrome (PMS) be prevented? Many women report benefits from a variety of lifestyle change including dietary changes, exercise and stress management. Dietary changes may include:

  • Increasing calcium intake.
  • Decreasing consumption of refined sugar.
  • Decreasing or avoiding caffeine and nicotine, which act as stimulants and can increase tension and anxiety as well as interfere with sleep patterns. For some women, the severity of PMS symptoms increases as caffeine consumption increases.
  • Decreasing alcohol consumption, this can act as a depressant. If you experience PMS, you may have an increased sensitivity to alcohol premenstrually.
  • Decreasing salt intake and increasing water consumption to avoid water retention and bloating.
  • Avoiding sodas, which may contain high levels of caffeine, salt, sugar and/or artificial sweeteners.
  • Drinking natural diuretics, such as herbal teas.

Ironically, some PMS symptoms, such as mood swings, irritability, bloating, hunger, carbohydrate cravings and fatigue, may lead you to consume foods that aggravate the condition.

Premenstrually, you may crave either refined sugar (usually combined with chocolate) or fat (combined with salt). Generally, foods high in refined sugars and fat temporarily raise energy levels. But within several hours or less, as your body metabolizes these foods, you may “crash,” meaning you’ll feel worse than before you ate them. Foods high in sugar content can also leave you feeling jittery.

To alleviate mood swings and fatigue, try adding more high-quality, complex carbohydrates to your diet such as:

  • Whole grain breads, pastas and cereals
  • Potatoes (white or sweet)
  • Rice (preferably brown or wild)
  • Fresh vegetables, particularly corn and legumes, such as peas, chickpeas and lentils
  • Fresh fruits

These complex carbohydrates help keep blood sugar levels even while providing your body with a long-lasting source of energy.

It’s not uncommon for your appetite to increase just before your period begins. To combat the munchies and extra weight gain, try eating smaller, low-fat healthful meals using the food choices listed above.

Make sure you include adequate calcium in your diet; calcium may help prevent irritability, anxiety and other PMS symptoms. Good sources of calcium include:

  • Low-fat milk and milk products like yogurt, ice cream and cheese
  • Broccoli
  • Dark greens (like turnip greens)
  • Green or red cabbage (raw)
  • Cooked collards
  • Salmon and sardines
  • Soy products, such as tofu and soy milk
  • Calcium-fortified orange and grapefruit juices

Another good way to prevent PMS symptoms is through regular exercise in the form of aerobic activities such as brisk walking, jogging, biking or swimming. You will get the greatest benefits from exercise if you do it for at least 30 minutes, five or more days a week. But even taking a 20- to 30-minute walk three times a week can:

  • Increase endorphin and serotonin production, brain chemicals that may help decrease pain and discomfort and improve mood, respectively
  • Decrease stress and anxiety
  • Increase REM sleep

Other lifestyle changes that will help you control PMS include:

  • Sleeping consistent hours
  • Establishing a bedtime routine to help cue body and mind for sleeping
  • Keeping a PMS symptom checklist, also called a menstrual cycle diary, to identify when symptoms and which symptoms occur so you can be prepared for them.

Severe PMS symptoms are rare. A small percentage of women who have severe symptoms have premenstrual dysphoric disorder (PMDD). PMDD affects between 3 and 8 percent of women. This is characterized in the new edition of the Diagnostic and Statistical Manual of Mental Disorders.

The symptoms of PMDD may include:

  • depression
  • thoughts of suicide
  • extreme anxiety
  • anger with severe mood swings
  • crying spells
  • a lack of interest in daily activities
  • Insomnia
  • binge eating
  • painful cramping
  • bloating

The symptoms of PMDD may occur due to changes in your estrogen and progesterone levels. A connection between low serotonin levels and PMDD also exists.

DID YOU KNOW?

PMS and PMDD symptoms can recur, but they typically go away after the start of menstruation. A healthy lifestyle and a comprehensive treatment plan can reduce or eliminate the symptoms for most women.

Mood swings and irritability are the most common and most severe PMS symptoms. Talk to your doctor or nurse about ways to help relieve your symptoms.

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