Premenstrual Syndrome (PMS)
by Carolyn Ross,
Table of Contents:
Premenstrual syndrome, or PMS, has become a household term in
recent years. Despite this fact, it is still not fully understood.
We know that it tends to occur after ovulation, the midpoint of
the menstrual cycle, during the last 3 to 14 days of your cycle.
During this time, a variety of changes occur in the body or mood,
and some of these may cause discomfort or distress. While over
150 different PMS symptoms have been documented, some tend to
occur more frequently.
Here is a breakdown of some of the more common ones and the
percentage of women who are affected:
|Anxiety, irritability, mood swings, tension
70 - 90%
|Bloating, fluid retention, weight gain, breast
|Sweet cravings, increased appetite, headache,
30 - 40%
|Confusion, crying, depression, forgetfulness,
1 - 20%
When Premenstrual Syndrome was first defined in 1931, researchers
suggested that it was due to a hormonal imbalance related to the
menstrual cycle. In fact, PMS does occur only during the childbearing
years and seems to peak when a woman is in her thirties and subsides
during pregnancy. In recent years, mental health clinicians have
identified certain psychosocial conditions which seem to predispose
women to PMS. In spite of many clues, however, researchers have
been unable to find a cause. As a result, a wide variety of treatment
options is available. Together with your doctor and other health
professionals, you may need to perform some trial and error to
find the approach that works best for you.
Your Physician or Nurse Practitioner - Cause of PMS Symptoms
Determining whether your symptoms are actually PMS symptoms
is a good first step in your treatment plan. Your physician or
nurse practitioner will first evaluate your general health and
specific symptoms. Simple laboratory tests, such as blood tests
or urinalysis, can rule out other conditions with similar symptoms,
such as clinical depression or thyroid problems. You may be checked
for sexually transmitted diseases if you experience pelvic pain.
You should also receive a thorough physical exam to check for
other undiagnosed medical conditions.
After ruling out unrelated physical causes for your symptoms,
the next step is to diary your symptoms over a period of time
to verify their type, severity and duration. You may use an ordinary
calendar to record the days and details of the symptoms. It may
also be helpful to keep an accompanying journal to record the
effects of these symptoms on your daily activities. Then, careful
analysis of your records can fine tune treatment recommendations
or even rule out Premenstrual Syndrome (if, for example, you have
symptoms for longer than two weeks out of the month).
Depending upon your needs and symptoms, some prescription and
over-the-counter (OTC) medications may be indicated. Prescription
medications include oral contraceptives, diuretics and natural
progesterone. Certain OTC medications such as Anaprox or ibuprofen
can help manage painful cramps. There are many "PMS Symptom
Formulas" on the market, but you should check with your doctor
before taking these to avoid possible harm. Finding just the right
approach for you may take some time and experimentation, so be
patient and communicate your needs and concerns to your physician
or nurse practitioner.
Acupuncture and Traditional Chinese Medicine - 3 Menstrual Cycle
The practitioner of Traditional Chinese Medicine (TCM) and acupuncture
can provide you with some very effective complementary treatment
of PMS symptoms. Once your TCM practitioner has verified that
your symptoms are a result of PMS, they will generally recommend
a cyclic treatment. The first part of the treatment will consist
of twice-weekly acupuncture between days 7 and 28 of your menstrual
cycle. This will be complemented by herbal remedies taken as directed.
Normally the treatment is required for two to three cycles. This
treatment generally relieves at least 80 percent of PMS symptoms
and lasts for months or years unless other factors trigger problems
Counseling and Psychotherapy
While certain forms of anxiety, anger, frustration, irritability
or depression may be more related to the physical changes brought
about by Premenstrual Syndrome, there may be deeper issues with
which you need help. A skilled mental health professional can
help to identify any hidden psychological problem. They can also
help you find ways to cope more effectively with the emotional
issues surrounding your PMS. You can learn how to deal with family
and work conflicts, or ways to express anger and frustration.
One way to help yourself is to recognize the changes in your
mood and body and plan ahead for them. Plan not to expect too
much from yourself on those difficult days. You may want to get
help from others in daily chores, communicate your feelings to
those around you, and avoid setting unnecessarily difficult goals
Stress Reduction and Therapeutic Massage
Stress can exaggerate existing PMS symptoms, contributing to
the feeling of being out of control. A relaxing massage is one
effective way to relieve stress, reduce discomfort and produce
a feeling of well-being. Also, some simple stress-relieving exercises
performed on a regular basis can bring you a feeling of peace
and calm. Following are a few of the many techniques you may wish
to learn more about:
- Deep abdominal breathing--induces a state of peace and relaxation
and counteracts the shallow breathing that can often be induced
- Progressive relaxation--helps you discover and relax tense,
- Affirmations and visualization--create the mind-body connection
to enhance relaxation and natural healing.
- Meditation--calms the mind and relaxes the body.
A balanced program of physical activity can provide significant
relief from both physical and emotional symptoms of Premenstrual
Syndrome. Regular, aerobic exercise (such as walking and cycling)
actually improves estrogen metabolism, reducing symptom-inducing
imbalances. These activities also enhance alertness and have a
mood-elevating effect, helping to smooth out those sharper emotional
fluctuations. Also, regular exercise enhances appetite control
and restful sleep.
Your most vigorous physical activity should be in the early days
of your menstrual cycle. Then, on the days when you're most prone
to PMS symptoms, try lower intensity, low impact aerobic activity
(such as walking, cycling or stationary equipment) combined with
gentle stretching. This will reduce the stress on your breasts
and abdomen at the time when they are more sensitive.
If you've gotten out of the exercise habit, try starting with
short bouts done consistently. Try not to drop below four days
per week, even if you must begin with 10-minute sessions and work
your way up to 30 or 45-minute bouts. Reward yourself for your
efforts by making exercise fun or treating yourself when you meet
While more research is needed, researchers have identified many
dietary links with PMS symptoms. For example, one study revealed
that Premenstrual Syndrome patients consumed more refined carbohydrates,
sugar and sodium, and less magnesium, zinc and iron than women
without PMS. As a general rule, a diet rich in whole grains, legumes,
fruits and vegetables combined with moderate amounts of lean protein
and certain unsaturated fats can make a big difference to some
Premenstrual Syndrome sufferers. Some women find that eliminating
animal protein entirely on those days when PMS symptoms are the
most intense, provides some relief. Following are more specific
- Make it a goal to eat at least eight servings per day of high-quality,
fiber-rich complex carbohydrates: fruits, vegetables, whole
grains and legumes.
- Add about a tablespoon per day of safflower or flax seed oil
to your diet. At the same time, limit your intake of animal
fat, since it directly influences estrogen metabolism.
- Choose a vitamin/mineral supplement that contains 100 percent
of the RDA for calcium, magnesium, zinc, iron, and the B-complex
vitamins, and no more than 400 IU of vitamin E.
- While more research is needed, preliminary studies have shown
that 50 to 150 mg per day of vitamin B6 taken starting on day
ten of the menstrual cycle through day three of the following
cycle has benefitted some women.
- It is important to limit your intake of refined starches and
sugars, even if they are low fat! (Examples are baked goods
made with refined flour and sugar such as cookies, muffins,
cakes, doughnuts, etc.) A good rule of thumb for refined sugar
is to limit your intake to no more than 3 teaspoons per day.
- Limit your salt intake if you are prone to fluid retention
- Limit or eliminate your consumption of alcohol, caffeine and
chocolate. If you do use alcohol, limit it to not more than
five drinks per week. To determine if you are caffeine sensitive,
eliminate it entirely for several weeks to see if your symptoms
are reduced. If the chocolate cravings become overwhelming,
try small quantities with meals, add cocoa to nonfat milk, or
drizzle some low-fat chocolate syrup over fruit.