PMS - the "evil twin" of the menstrual cycle

by Laurie B. Rosenblum, M.P.H.

For five days each month, June Summers, an active 42-year-old business manager, feels like a different person. She becomes high-strung and impatient, snaps at her partner, and doesn't trust herself to make important decisions. Physically, she feels terrible. She has outrageous salt cravings and gains at least five pounds over the five days. At first, she couldn't understand why she felt so different. But when she noted these changes on her calendar for several months, she realized she had some classic symptoms of premenstrual syndrome (PMS).

PMS Knowing when her symptoms occur and that they will go away in a few days has helped June learn to live successfully with her PMS. When her symptoms come on, she takes calcium, avoids coffee, and goes on long walks to relax. If she feels really bloated, she takes a low-dose diuretic. But most important, she does not plan business meetings or other stressful activities during the last two days before her period. She tells the people close to her that she is premenstrual so they can provide support and understanding.

What is PMS?

PMS is a group of symptoms that occur from one to two weeks before the start of a woman's period. They usually disappear when menstrual bleeding starts. Within about two days most women feel better. PMS symptoms can occur anytime between puberty and menopause but are more likely to become a problem beginning in the mid-30s.

Most women experience some changes as their period approaches. A woman is considered to have PMS when these changes - physical and/or emotional - become uncomfortable and cause problems in her life. Symptoms can range from mild to severe and sometimes wreak havoc in relationships. Fortunately, some symptoms of PMS can be treated.

PMS affects about 40 percent of menstruating women. Researchers have not yet determined the cause of PMS. However, most think it is related to the hormonal changes during a woman's menstrual cycle.

What are the symptoms of PMS?

Many different symptoms can be part of PMS. They may vary in severity from one month to another. Every woman has her own individualized set of symptoms. Listed below are some of the most common ones:

  • bloating
  • fatigue
  • weight gain
  • dizziness
  • swelling in hands and feet
  • irritability
  • breast tenderness
  • anger
  • acne
  • depression
  • mood swings
     
  •  joints, muscles, and back
  • anxiety
  • food cravings
  • trouble concentrating
  • nausea
  • forgetfulness
  • constipation or diarrhea
  • emotional oversensitivity
  • insomnia
  • withdrawal

How do I know if I have PMS?

There are no laboratory tests for PMS. It is often misdiagnosed as other physical or emotional problems. Since the timing of PMS symptoms is its most distinguishing feature, keeping a calendar of your symptoms and exactly when they occur is the most important factor in diagnosis. This record helps show any patterns in your symptoms. Your health care provider can determine whether you have PMS based on your symptoms calendar along with a physical exam and health history.

Is there a treatment?

There are many kinds of treatment used to relieve PMS symptoms. Most have not been scientifically proven to be effective. However, most researchers and health care providers agree that changes in lifestyle--diet, exercise, and stress management--should be the first approach. The following are some of the most common suggestions:

  • Avoid sugar, salt, caffeine, alcohol, red meat, and other fatty foods.
  • Eat four to six small meals a day instead of three larger ones. Do not skip meals.
  • Exercise 20 to 30 minutes at least three times a week. Walking is helpful. Aerobic exercise, such as jogging, bicycling, or swimming, may provide even more relief.
  • Try relaxation techniques such as meditation, deep breathing, or yoga.
  • Try not to plan stressful activities or events during the time when your symptoms are worst.

Over-the-counter medicines, such as Advil and Motrin, may be helpful in relieving some of the physical symptoms of PMS, including headaches, breast tenderness, and cramps. A number of non-drug treatments, such as vitamins and minerals, evening primrose oil, herbs, massage, and acupuncture, have helped some women with a variety of symptoms. There is some evidence that additional calcium may help minimize some of the symptoms, especially those related to muscle aches, cramps, and tension.

There are several over-the-counter preparations that tout their ability to prevent or minimize the symptoms of PMS. At least two of these are powders that are mixed with water, the main ingredients of which are carbohydrate and flavoring. While not harmful, they are expensive--you can brew up the same basic blend at home.

If lifestyle changes and other treatments do not help after a few months, your health care provider may recommend a prescription medication. Diuretics sometimes ease bloating, breast tenderness, and weight gain. Birth control pills seem to help relieve physical symptoms in some women but cause more PMS symptoms in others. Antidepressants, especially Prozac, can relieve emotional symptoms including depression and anxiety. Anti-anxiety medicines, particularly Xanax, have also been shown to help. Progesterone was used widely until recently, although there was no research proving it effective. Doctors are now more likely to prescribe the scientifically proven antidepressants and anti-anxiety medications.

What else can you do?

Learn as much as possible about PMS to help you gain more control over your symptoms. Ask your family, friends, and partner to provide support. Consider joining a PMS support group to share experiences with other women who have similar problems. If your symptoms are creating major difficulties in your life, a counselor or psychotherapist may be able to help you cope more effectively.

Until recently women were told by the medical profession that PMS was "a part of their nature" and something they just had to live with. PMS is now understood as a medical condition, and treatments are available. So don't suffer in silence -- seek help.

Suggestions for Partners

When your partner's PMS symptoms are at their worst, she may seem like a different person. You may feel confused, angry, or sad about the changes she goes through and the effects on your relationship. Here are some tips to help you cope:

  • Understand that PMS is a real medical disorder and that your partner is also having a hard time dealing with the physical and emotional changes she's experiencing.
  • Talk with your partner about how both of you are feeling.
  • Try to not take her actions personally.
  • Be patient and empathetic. Tell your partner you want to help her.
  • Show interest and support by learning more about PMS and encouraging your partner with any necessary lifestyle changes.
  • When her symptoms come on, provide some extra help with things such as household chores and child care.
  • Take care of yourself too. Your partner's PMS can also be stressful for you.