Women's Issues
Premenstrual Syndrome (PMS)
by Carolyn Ross, MD

Introduction

Premenstrual syndrome, or PMS, has become a household term in recent years. Despite this fact, it is still a condition that is not fully understood. What we do know is 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:

Hormonal Imbalance

At the time that 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, there are some prescription and over-the-counter (OTC) medications which 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 Treatment

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 oral herbal pills taken three times per day. 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 once again.

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 more effectively 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 and tasks.

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 by stress.
• Progressive relaxation--helps you discover and relax tense, tight muscles.
• Affirmations and visualization--create the mind-body connection to enhance relaxation and natural healing.
• Meditation--calms the mind and relaxes the body.

Physical Activity

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 your goals.

Nutrition

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 guidelines:

• 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 and bloating.
• 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.