PMS Treatment Options

Premenstrual Syndrome (PMS) is a condition that affects women from every culture and walk of life. PMS occurs after ovulation during the week or two before menstruation starts. The symptoms are relieved when a menstrual period begins. Up to 40% of women have symptoms that can disrupt their daily lives, and in 5% of these women those symptoms reach a point at which they are debilitating.

PMS can begin anytime from puberty on, although the most common age for its start is when a woman is in her late teens and early twenties. The symptoms may worsen during the perimenopause (the time just before menopause) but usually stop once menopause occurs.

At times it can be difficult for a woman to get a diagnosis of this disorder, which can range from mild fluid retention, to severe symptoms that cause a disruption of the woman's daily routine. To make the diagnosis, a doctor first has to rule out other causes, and the symptoms must be restricted to the period of a woman's cycle after ovulation occurs; the last two weeks of her cycle.

Symptoms of PMS

The symptoms of PMS can include:

  • Food cravings (especially sweet or salty foods)
  • Irritability
  • Back pain
  • Anxiety/depression
  • Emotional reactivity
  • Difficulty concentrating
  • Fatigue/low energy
  • Acne
  • Change in sexual desire (libido)
  • Mood swings (including crying jags)
  • Fluid retention/bloating
  • Breast tenderness and swelling
  • Headaches
  • GI distress/nausea/abdominal bloating

Most women do not experience all of the symptoms of PMS at one time. Instead, they will experience a "cluster" of symptoms that may vary from month to month.

A severe form of PMS is called Premenstrual Dysphoric Disorder, with symptoms that are similar to major depression but only occurring during the two weeks after ovulation. This disorder requires medical therapy and often responds quickly to antidepressants.

What Causes PMS?

The causes of PMS are not completely understood, and may be partially genetic. Some professionals believe that the symptoms of PMS are caused by an overabundance of estrogen, and a relative lack of progesterone in the body or a hormonal imbalance. Others have found that women with PMS have an abnormal response to the female hormones. Changes in serotonin levels also seem to play a part in creating symptoms. High levels of stress, depression, and poor nutrition can each make the symptoms of PMS worse.

The Many PMS Treatment Options

If you have PMS, your doctor will probably start with emphasizing lifestyle changes in its treatment. If these aren't enough to bring relief, then other methods such as medication may be considered. Education about PMS can help to relieve anxiety, especially if you are worried that the symptoms might be caused by disease. Learning what to expect and what causes PMS can help with coping with it.

Dietary changes may help relieve PMS symptoms. Your doctor or dietitian will probably recommend that you limit your intake of certain foods, such as sugar, caffeine, salt, red meat, and alcohol. Reducing the animal fat intake and increasing the amount of complex carbohydrates in the form of fresh fruits, vegetables, whole grains, and cereals can often bring symptom relief.

The American College of Obstetricians and Gynecologists (ACOG) recommends that you keep a PMS diary for at least three months to help your doctor with making a correct diagnosis. An important part of identifying PMS and ruling out other diseases is to keep track of the symptoms that you experience, when you experience them, and when they are relieved.

Losing weight can sometimes help the symptoms of PMS, since excess weight causes them to increase. Shedding excess pounds is also good for your overall health and self-esteem, and will help you avoid certain health problems such as type 2 diabetes or high blood pressure.

Regular aerobic exercise at least three times a week for 20 minutes can help, since women who exercise regularly experience less symptoms. Exercise can also help protect you against heart disease, high blood pressure, and contributes to overall toning and good health.

Antidepressant therapy with selective serotonin reuptake inhibitors can also prevent and treat PMS. In fact, Premenstrual Dysphoric Disorder (PMDD), a severe form of PMS, is treated with Sarafem (equivalent to Prozac) and often responds quickly to medication.

Vitamin and mineral supplements offer relief for many women. ACOG and the American Academy of Family Physicians both recommend supplementation with calcium, 1000 mg daily. This has been shown to be effective in studies to relieve symptoms, and can also help prevent osteoporosis. Vitamin E (400 IU/day) has also been found to relieve breast tenderness and also exerts an antioxidant effect against cardiovascular disease.

Magnesium levels drop during menstruation and can cause cravings for sugar. Supplementing the diet with 400 mg can help reduce these cravings, and can also help with breast tenderness. Manganese supplementation (6 mg) is also helpful for some women.

High dose vitamin B has not been shown to be effective in relieving symptoms of PMS, and can cause peripheral nerve damage. The use of primrose oil is still controversial, with some physicians recommending it for breast tenderness and pain, while others feel it is of no benefit.

Oral contraceptives help some women with their symptoms if they are mostly physical, although this benefit must be weighed against the risk of side effects, and discussed with your medical doctor.

Gonadotropin Releasing Hormone agonists (GnRH agonists) have helped some women with severe symptoms, but it is expensive and has side effects such as an increased risk of osteoporosis which must be weighed against the benefit of therapy.

If you are experiencing severe fluid retention, your doctor will probably first suggest limiting your intake of salt. But if the symptoms continue, Spironolactone, a diuretic, can help with severe fluid retention symptoms in some cases. It can only be prescribed by a physician.

Some over-the-counter non-steroid anti-inflammatory agents, which are also prostaglandin inhibitors, such as ibuprofen can also help with pain and symptom relief. Aspirin should be avoided because of its anticoagulation effect as it can make bleeding heavier and more prolonged.

Stress management and getting support from your family can also help. Some women let their family know ahead of time when their "tough days" are. You may find that personal prayer, meditation, deep breathing, or other stress management techniques can help relieve some of the emotional symptoms related to PMS.

PMS symptoms can range from a minor annoyance to a debilitating disorder, but our understanding and ability to treat it have increased greatly in recent years. As a woman, you can now choose from a range of options in helping to treat your particular symptoms, and information to help you become better informed about this condition.

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