PMS Explained

PMS (premenstrual syndrome) affects most women at one time or another. In fact, it’s estimated that three out of four women suffer from PMS regularly.

What is PMS?

Premenstrual syndrome refers to a cluster of physical and emotional changes a woman undergoes during the two weeks before bleeding actually occurs. This time frame is referred to as the ‘luteal cycle’. At the onset of her period, symptoms usually disappear.

What Are the Symptoms of PMS?

Symptoms of PMS are numerous and may include any or all of the following:

• Erratic mood swings
• Abdominal pain, pressure and cramping
• Moderate to severe depression
• Uncontrolled aggression and hostility
• Uncharacteristic outbursts of anger
• Brian fog or lowered concentration
• Social isolation or withdrawal
• Brain fog or mental confusion
• Anxiety
• Fatigue
• Irritability
• Difficulty sleeping, insomnia
• Decreased or heightened sexual desire
• Headaches, migraines
• Tenderness in breasts
• Weight gain
• Joint pain
• Swelling in feet and hands
• Mental confusion
• Unusual cravings, changes in appetite and thirst
• Bloating
• Fluid retention
• Skin problems
• Hair loss
• Gas (flatulence)
• Indigestion
• Obsessive/compulsive behavior such as an overwhelming need to clean, organize, etc.
• Suicidal thoughts or attempts
• Dizziness or light-headedness

What Causes PMS?

The exact cause has not been pinpointed, but lowering levels of the sex hormones, estrogen and progesterone are believed to be key factors. Serotonin, a neurotransmitter responsible for feelings of well-being and happiness, also drops. Though this is a natural process, and necessary to prepare the body for reproduction, the monthly depletion can cause a hormonal imbalance, wreaking havoc on women physically and emotionally. If you are experiencing extreme discomfort and PMS is negatively affecting you physically and psychologically, do not hesitate to see your doctor.

What is Dysphoric Menstrual Syndrome?

Most women have mild to moderate cases of PMS which can be annoying, or at most, uncomfortable. These symptoms cause little or no disruption in their daily routines, and usually does not warrant medical help. However, about 5% of women with PMS suffer from what is categorised as dysphoric menstrual syndrome (PMDD), which is a far more severe and negatively impacts their lives. These women require more aggressive psychological or medicinal intervention.

The criteria to meet the diagnosis of PMDD is that the patient has at least five of the emotional symptoms mentioned above during their luteal cycle. The presence of these symptoms is usually more exaggerated. These are a few that we look for:

• Suicidal tendencies
• Anxiety or full-blown anxiety attacks
• Extreme social isolation
• Impairment or total collapse of relationships
• Depression
• Radical mood swings
• Highly pronounced or non-existent libido
• Inability to focus on or perform normal daily activities and tasks

Approximately another 20% meet the definition of ‘subthreshold’ PMDD, meaning that they may be monitored diligently to avoid full-blown PMDD. This particular disorder is classified as ‘menstrually related mood disorder’ (MRMD) and may also need some medicinal or psychological treatment. Like PMS, hormone dissipation during the menstrual cycle may be the underlying cause.

Are There Any Tests That Accurately Diagnose PMS?

There are no specific lab tests to diagnose premenstrual syndrome. Instead, we’ll need to study your medical history to establish if you are suffering from it. It is very important to be completely truthful so that we can help you. We know that some of these symptoms may be frightening to you, and perhaps, at times, embarrassing to discuss, but getting the full picture allows us to give you the best and most effective advice and care. Keeping a diary of your symptoms for a few months helps.

Three of the main things we look for are:

• Have your symptoms been consistently bothering you several days before your period, and recurred for at lease three consecutive cycles?
• Do they usually end on or within a few days of bleeding onset?
• Have they negatively impacted your day to day routine and social life?

Even jotting down specific odd thoughts and ideas, levels of fatigue, etc., can be helpful. This allows us to properly determine which hormonal imbalance is affecting you more and enable us to deal with the more troublesome symptoms accordingly. Remember to list the dates as these symptoms occurred, and exactly when menstruation itself began and ended.

Can PMS be Treated?

Mild to moderate PMS can be fairly easily managed with a few lifestyle changes and over-the-counter pain relievers. Heating pads or warm baths may help with pain, and ice packs with headaches. Topical rubs and ointments can reduce inflammation and joint pain. You may be advised to limit or completely eliminate salt, alcohol, caffeine, sugar and any artificial sweeteners as they contribute to many sleep and anxiety issues.

Other recommendations to help alleviate PMS symptoms are:

• Exercise regularly, throughout the month, not just when your problems appear. Try to get at least 30 minutes of brisk walking, jogging, dancing, etc. three times a week to elevate endorphins that counteract stress, pain and depression. Endorphins like serotonin, dopamine and oxytocin, are the body’s natural feel-good narcotics and pain killers.
• Acupuncture or massage: Who doesn’t feel good after a spa day and a little pampering? And acupuncture is a time- honored holistic process that has been proven to be advantageous in treating many emotional and physical menopause symptoms.
• Relaxation therapy: Yoga, meditation, breathing exercises, biofeedback, etc. go a long way to ameliorating PMS-related depression and anxiety.
• Support groups and cognitive therapy: Discussing your symptoms and emotions with other women who can relate to them can actually lower numerous PMS issues.
• Proper diet: A diet rich in vegetables, fruits, grains and protein can ward off various PMS problems. Avoid carbohydrates during this time.
• Getting enough sleep: Disruptive or insufficient sleep can cause additional hormonal imbalances that can augment those already affected by PMS.
• Eating smaller meals a day instead of three large ones can reduce gastrointestinal discomfort.

Some herbs and supplements may counteract PMS symptoms, although some have not been studied fully so it’s always best to get these from a healthy diet instead. Before taking them, it is recommended that you speak to your physician. Though they may help, the medications you already take may interact with them and cause adverse, sometimes dangerous interactions. Here is a list of the vitamins, herbs and supplements and the symptoms they may alleviate:

• Calcium for calcium deficiency that many experts believe contribute to PMS and might stave off changes in appetite, fatigue, erratic emotions, physical discomfort, and depression
• B6 vitamins for metabolism and immune response
• Folic acid for lethargy and fatigue
• Omega-3 for cramps, nausea, headache and fatigue
• Chaste berry for breast pain, anxiety, depression, food cravings, headaches, cramps, water retention, and swelling
• Magnesium for headaches, low blood sugar, dizziness, sugar cravings, and mood swings
• Evening primrose for breast discomfort.
• Gingko biloba for mood swings, flagging memory, low concentration, and breast tenderness
• Dandelion leaf for bloating
• Vitamin E for breast discomfort and swelling

For more severe PMS, your doctor may prescribe one or more of the following:

• Diuretics
• Antidepressants
• Contraceptives
• Hormone therapy
• Prescription pain relief
• Anti-anxiety medication
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

How Can Cherokee Women’s Health Specialists Help Me?

Because we deal with women’s health issues daily, we are aware of the debilitating effects of PMS. We would never minimize the detrimental influence it can have on you and yours.

We are here to offer counsel, diagnosis, empathy, and treatment, using all our expertise and knowledge of the most up-to-date information medical science has to offer. Our staff includes three doubly accredited urogynecologists with the outstanding certification in OB/GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This qualifies us to diagnose and treat all your female-related problems. Additionally, our staff includes specialists in other fields related to a women’s unique needs.

To book an appointment to further discuss your PMS symptoms, call 770.720.7733.