Premenstrual syndrome (PMS) refers to symptoms that occur between ovulation and the onset of menstruation. The symptoms include both physical symptoms, such as breast tenderness, back pain, abdominal cramps, headache, and changes in appetite, as well as psychological symptoms of anxiety, depression, and unrest. Severe forms of this syndrome are referred to as premenstrual dysphoricdisorder (PMDD). These symptoms may be related to hormones and emotional disorders.
Approximately 75% of all menstruating women experience some symptoms that occur before or during menstruation. Premenstrual syndrome encompasses symptomssevere enough to interfere with daily life. About 3-7% of women experience the more severe premenstrual dysphoric disorder (PMDD). Women with PMDD typically feel deeply depressed and/or irritable for a week or two before or duringmenstruation, and their symptoms are much worse than those associated with PMS. These symptoms can last 4-10 days and can have a substantial impact on a woman's life. Treatment for PMDD may include exercise, psychotherapy, and/or antidepressant medication.
The reason some women get severe PMS while others have none is not understood. PMS symptoms usually begin between the ages of 20 and 30. The disease may run in families and is also more prone to occur in women with a history of psychological problems. Overall however, it is difficult to predict who is mostat risk for PMS.
Because PMS is restricted to the second half of a woman's menstrual cycle, after ovulation, it is thought that hormones play a role. During a woman's monthly menstrual cycle, which lasts from 24-35 days, hormone levels change. Thehormone estrogen gradually rises during the first half of a woman's cycle, the preovulatory phase, and falls dramatically at ovulation. After ovulation, the postovulatory phase, progesterone levels gradually increase until menstruation occurs. Both estrogen and progesterone are secreted by the ovaries, which are responsible for producing the eggs. The main role of these hormones isto cause thickening of the lining of the uterus (endometrium). However, estrogen and progesterone also affect other parts of the body, including the brain. In the brain and nervous system, estrogen can affect the levels of neurotransmitters, such as serotonin. Serotonin has long been known to have an effecton emotions, as well as eating behavior. It is thought that when estrogen levels go down during the postovulatory phase of the menstrual cycle, decreasesin serotonin levels follow. Whether these changes in estrogen, progesterone,and serotonin are responsible for the emotional aspects of PMS is not knownwith certainty. However, most researchers agree that the chemical transmission of signals in the brain and nervous system is in some way related to PMS. This is supported by the fact that the times following childbirth and menopause are also associated with both depression and low estrogen levels.
Studies have shown that up to 80 percent of the women who experience PMS symptoms are primarily bothered by anxiety, irritability, and mood swings, with anxiety followed by depression in some cases. When properly balanced, estrogenand progesterone promote normal function of the uterus, vagina, and breast.Some doctors believe that when there is a predominance of estrogen in the body, women experience anxiety, and that a predominance of progesterone causes women to become depressed.
But the symptoms for PMS are varied and many, including both physical and emotional aspects that range from mild to severe. The physical symptoms includebloating, headaches, food cravings, abdominal cramps, headaches, tension, andbreast tenderness. Emotional aspects include mood swings, irritability, anddepression. Many women experience severe personality changes; they say that they become irritable or mean during the PMS period, often yelling at their spouses, or snapping at friends or coworkers. They may then spend the rest of the month repairing the emotional damage they have done to their relationshipsduring their PMS periods.
The best way to diagnose PMS is to review a detailed diary of a woman's symptoms for several months. PMS is diagnosed by the presence of physical, psychological, and behavioral symptoms that are cyclic and occur in association withthe premenstrual period of time. PMDD, which is far less common, was officially recognized as a disease in 1987. Its diagnosis depends on the presence ofat least five symptoms related to mood that disappear within a few days of menstruation. These symptoms must interfere with normal functions and activities of the individual.
There are many treatments for PMS and PMDD depending on the symptoms and their severity. For mild cases, treatment includes vitamins, diuretics, and painrelievers. Vitamins E and B6 may decrease breast tenderness and help with fatigue and mood swings in some women. Diuretics that remove excess fluid from the body seem to work for some women. For more severe cases and forPMDD, treatments available include antidepressant drugs, hormone treatment,or (only in extreme cases) surgery to remove the ovaries. Hormone treatment usually involves oral contraceptives. This treatment, as well as removal of the ovaries, is used to prevent ovulation and the changes in hormones that accompany it. Recent studies, however, indicate that hormone treatment has littleeffect over placebo. Note: it is important to remember when using any medication or hormone to treat the symptoms of PMS that there may be problems withside effects, that the symptoms will only be controlled as long as one continues taking the medicine, and that the treatment may not alleviate all symptoms.
The most progress in the treatment of PMS and PMDD has been through the use of antidepressant drugs. The most effective of these include sertraline (Zoloft), fluoxetine (Prozac), and paroxetine (Paxil). They are termed selective serotonin reuptake inhibitors (SSRIs) and act by indirectly increasing the brain serotonin levels, thus stabilizing emotions. Some doctors prescribe antidepressant treatment for PMS throughout the cycle, while others direct patientsto take the drug only during the latter half of the cycle.
There are also some alternative treatments that can affect both serotonin andhormone responses, as well as affect some of the physical symptoms of PMS.
One of the easiest ways to control the symptoms of PMS is through diet, as nomedication can completely overcome the effects of a poor diet. Foods that are known to worsen the symptoms of PMS (and which therefore should be avoided)are those that are high in refined sugars and fats, and those that are highly processed and full of chemicals. Foods made from whole grains, legumes, seeds and nuts, vegetables, seasonal fruits, and unsaturated vegetable oils haveall been found to reduce PMS symptoms. It has also been observed that Japanese women who eat a traditional diet of grains, fermented bean products, and sea vegetables have much less tendency to experience diseases associated withhormonal imbalance, such as PMS; examples of these traditional foods that canbe found in health food stores and oriental markets include miso (a high-nutrient fermented soy product), tamari soy sauce; kelp; gomasio (sea salt combined with ground and toasted sesame seeds); and umeboshi plums (traditionallyused to maintain the body's acid-alkaline balance).
Some women find relief with the use of vitamin and mineral supplements. Magnesium can reduce the fluid retention that causes bloating, while calcium may decrease both irritability and bloating. Magnesium and calcium also help relaxsmooth muscles and this may reduce cramping. Zinc displaces copper in the body, which is important because an overabundance of copper can increase moodiness and produce higher levels of estrogen. Vitamin E may reduce breast tenderness, nervous tension, fatigue, and insomnia. Vitamin B6 can helpto regulate mood swings, irritability, fluid retention, breast tenderness, bloating, sugar craving, and fatigue associated with PMS. Vitamin B5supports the adrenal glands and may help reduce fatigue. Vitamin D aids in the absorption of calcium, and can, like Vitamin A, decrease skin oiliness that exacerbates premenstrual acne. Among the Vitamin-B Complex factors are choline and inositol, which enhance the liver's ability to break down fatty foodsand fat-soluble hormones such as estrogen. Inositol is also a central nervous system tranquilizer, and may help to calm premenstrual anxiety and irritability.
One important way to alter hormone levels may be by eating more phytoestrogens. These plant-derived compounds have an effect similar to estrogen in the body. One of the richest sources of phytoestrogens is soy products, such as tofu. Additionally, many supplements can be found that contain black cohosh (Cimicifugaracemosa) or dong quai (Angelica sinensis), which are herbs high in phytoestrogens. Red clover (Trifolium pratense), alfalfa (Medicago sativa), licorice (Glycyrrhiza glabra), hops (Humulus lupulus), and legumes are also high in phytoestrogens. Increasing theconsumption of phytoestrogens is also associated with decreased risks of osteoporosis, cancer, and heart disease.
Many of the antidepressants that have proven effective in the treatment of PMS and PMDD act by increasing serotonin levels. An alternative means of achieving this is to eat more carbohydrates. For instance, two cups of cereal or acup of pasta has enough carbohydrate to effectively increase serotonin levels. An herb known as St. John's wort (Hypericum perforatum) has stood upto scientific trials as an effective antidepressant. As with the standard antidepressants, however, it must be taken continuously and does not show an effect until used for 4-6 weeks. There are also herbs, such as skullcap (Scutellaria lateriflora) and kava (Piper methysticum), that can relieve the anxiety and irritability that often accompany depression. An advantageof these herbs is that they can be taken when symptoms occur rather than continually. Chaste tree (Vitex agnus-castus) in addition to helping rebalance estrogen and progesterone in the body also may relieve the anxiety anddepression associated with PMS.
Adjunct therapies that have been prescribed for PMS symptoms include acupressure massage, massage of the neurolymphatic and neurovascular systems, and yoga.
The prognosis for women who suffer from PMS or PMDD is good. Most women who are treated for these disorders do well.
Because the causes of PMS and PMDD are not completely understood, preventionis difficult. Maintaining a healthy diet, one low in sugars and fats and highin phytoestrogens and complex carbohydrates, may prevent some of the symptoms of PMS. Women should try to exercise three times a week, keep in generallygood health, and maintain a positive self image. Because PMS is often associated with stress, the avoidance of stress or the development of better means to deal with stress can be important.