For three weeks out of every month you’re energetic, happy, upbeat and even- tempered, then it happens. A week before your period begins the change into a “mad women” happens. Your mood swings form frustration to irritability, to downright anger, even depression. Your breasts become tender to the touch, and your ankle, feet, hands and stomach swell so much that your clothes become to tight it’s uncomfortable to move. Somehow, despite the cramps and the headaches we manage to waddle to and from the refrigerator to satisfy those “junk food cravings”. Sounds awful? It is but it’s something that we as women deal with on a monthly basis. The dreaded is known as Premenstrual Syndrome or PMS.
Premenstrual Syndrome is also known as premenstrual tension, premenstrual dysphoria and most commonly PMS. PMS is a symptom or collection of symptoms that occurs regularly in relation to the menstrual cycle, with the onset of symptoms 5 to 11 days before the onset of menses and resolution of symptoms with menses or shortly thereafter (Yahoo 1). Another source describes PMS as a disorder characterized by a set of hormonal changes that trigger disruptive symptoms in a significant number of women for up to two weeks prior to menstruation. Of the estimated forty million sufferers, moor than five million require medical treatment for marked mood and behavioral changes. Often symptoms tend to taper off with menstruation and women remain symptom-free until the two weeks or so prior to the next menstrual period. These regularly recurring symptoms form ovulation until menses typify PMS (Lichten 1).
The symptoms that can occur are many. The most common physical symptoms can include headache, swelling of ankles, feet and hands, backache, abdominal cramps or heaviness, abdominal pain, abdominal fullness, gaseous muscle spasms, breast tenderness, weight gain, recurrent cold sores (herpes labialis), acne flare-up, nausea, bloating, bowel changes (constipation or diarrhea), decreased coordination, food cravings, decreased tolerance to sensory input like noise and light, and painful menstruation. Other symptoms not physical can include anxiety, confusion difficulty concentration, forgetfulness, poor judgment, depression, irritability, hostility, aggressive behavior, increased guilt feelings, fatigue, decreased self image, libido changes, paranoia, lethargic movement low self-esteem (Yahoo 2). The symptoms are obviously many and have a varying degree of severity. The next question that arises is what the cause could be.
The exact cause of PMS, headaches and depression are unknown. In fact, it is not known why some women have severe symptoms, some have mild ones, while others have none. It is generally believed that PMS patients, migraine and depression come from neurochemical changes within the brain. Hormonal factors, such as estrogen levels, may also be the cause. The female hormone estrogen starts to rise after menstruation and peaks around mid-cycle. It ten rapidly drops only to slowly rise and then fall again in the time before menstruation. Estrogen holds fluid and with increasing estrogen comes fluid retention; many women report weight gains of five pounds premenstrually. Estrogen has a central neurological effect: it can contribute to increase brain activity and even seizures. Estrogen can also contribute to retention of salt and a drop in blood sugar. PMS patients benefit from both salt and sugar restriction (Lichten 2). Another possible cause dates back almost sixty years. In the psychoanalytic essay on PMS by Karen Horney, she suggested that the tension preceding the period is caused by the unconscious denial of a desire for a child. In 1942 the first extensive psychological tests conducted on menstrual and premenstrual women. “Therese Benedek an d B.B. Rubenstein examined the emotional an hormonal swings of the menstrual cycle and found a tendency toward acute emotional response and dependent behavior during the premenstruum, which they attributed to changes in the production of estrogen an d to certain psychological factors. Since 1942, many attempts have been made to evaluate the premenstrual symptoms, but psychologist Mary Brown Parlee later concluded that there is no established proof that a measurable PMS even exists. The co relational studies and the Premenstrual Distress Questionnaire results of Moos in 1968 often predict, through their wording, the very symptoms that they expect to isolate. Most of the studies on violence and PMS fail to place women in appropriate subgroups. And in almost every case that involves proving PMS, a nonmenstruating control group is absent. Parlee suggests, as do Lennane and Lennane, that menstrual dysfunctions are more likely to have physiological that psychological origins (Delaney et al. 71).
PMS may be able to be prevented by making some lifestyle changes. These can include regular exercise 3 to 5 times per week and a balanced diet. The exercise is important because it reduces stress an tension, acts as a mood elevator, provides a sense of well-being and improves blood circulation by increasing the natural production of beta endorphins (Mayoclinic 2). The diet should include increased whole grains, vegetables, fruit, and decreased or no salt, sugar, alcohol, and caffeine. Daily supplemental vitamins and minerals may be administered to relieve some PMS symptoms. S multivitamin with B6 (100 mcg), B complex, magnesium (300mg), Vitamin E (400 IU) and vitamin C (1000 mg) may be recommended to alleviate irritability, fluid retention , joint aches, breast tenderness, anxiety, depression and fatigue (Lichten 2). Recognizing that the body may have different sleep requirements at different times during a woman’s menstrual cycle is also important. The importance of recognizing sleep requirements is because there is often increased activity prior to the worse symptoms of PMS. At this time, the woman may clean the house, function with little sleep, and feel euphoric. This is followed by the PMS symptoms, fatigue, exhaustion, depression and the inability to function. Women typically feel “out of control” at this time and this can cause the signs and symptoms of depression. Therefore it is important to get proper rest (Lichten 3).
There are no physical examination findings or lab tests specific to the diagnosis of PMS, although a thyroid test may rule out a thyroid condition that looks like PMS (St. Lukes 1). It is important that a complete history , physical examination (including pelvic exam), and in some instances a psychiatric evaluation may be conducted to rule out other potential causes for symptoms that may be attributed to PMS. It is also important to maintain a daily diary or log to record the type, severity, and duration of the symptoms. A “symptom diary” should be kept for a minimum of three months in order to correlate symptoms with the menstrual cycle. The diary will greatly assist the health care provider not only in the accurate diagnosis of PMS, but also with the proposed treatment symptoms. Complications may also occur. PMS symptoms may become severe enough to prevent women from maintaining normal function. Women with depression may note increasing severity of symptoms during the second half of their cycle and may require associated medication adjustments. The incidence of suicide in women with depression is significantly higher during the latter half of the menstrual cycle. Because of the severity that PMS can reach there are various treatments that have developed through the years (Yahoo 3).
There are various treatments for PMS and they may differ according to the individual and severity. Since 1953, hormonal therapies have been the main treatment. Kathrina Dalton, M.D., a family practitioner in England, evaluated the effectiveness of a program of aqueous progesterone suppositories on her own symptoms. When they were relieved, she repeated the study with 50 patients under the care of a leading gynecologic endocrinologist. They also experienced improvement. These aqueous progesterone suppositories have been found effective. They are safe during pregnancy, and can be used well into menopause. Since 1979, Day and others have reported on the use of low dose Danazol to control the worst PMS. Danazol is taken all month long and prevents the rise and fall of estrogen level. In more than 10 medical articles, the success rate for controlling PMS in more than 80 percent. Although Danazol has the side effects in some of acne and fluid retention, most are easily treated. Rarely have there been liver or bone changes with these dosages of medication. Some patients are so will controlled on hormonal therapy that they are able to discontinue the medications prescribed by the psychiatrist. SSC Yen in 1985 showed that luprolide acetate, a long-acting agent for endometriosis, can rapidly eliminate the worse PMS symptoms (Lichten 3). Another treatment is oral contraceptives. Oral contraceptives stop ovulation so PMS symptoms usually are relieved. The newest oral contraceptives are very low-dose, so there are few side effects. Prostaglandin inhibitors, such as aspirin and ibuprofen, may be prescribed for women with significant pain, including headache, backache, menstrual cramping and breast tenderness. Diuretics may be prescribed for women found to have significant weight gain due to fluid retention. Menopause is also a cure for PMS (Mayoclinic 3).
The most important thing to know is that the pain and mood swings are real. Women need not feel that they are “going crazy” for these two weeks every month. They are experiencing an exaggeration of normal function, for which there is treatment.