Premenstrual Syndrome
Premenstrual
Syndrome
Getting Along in Spite of It
I have PMS."
You've probably said it to your friends at one time or another. They've probably said it to you. None of you has to say much more. The three-word statement, kind of a universal among American women, says it all.
It says you're feeling out of sorts, anxious and moody.
It says that you feel ugly and fat and that it's probably a bad hair day.
And it also says you're feeling less than your usual youthful self. You feel old, tired, achy, irritable, bloated, depressed and withdrawn. You're having trouble concentrating. Your back hurts. You don't feel too much like doing anything or seeing anybody.
Your zip for life has been zapped.
Defining PMS
The term PMS (premenstrual syndrome) has become part of the American vernacular; women use it to refer to how they feel before their periods. And many do experience premenstrual symptoms that are uncomfortable, disturbing and difficult. But not all women who say or think they have PMS necessarily do.
There's lots of disagreement among experts about how PMS should be defined, but most agree that for a woman to officially have PMS, her symptoms must recur in two of every three menstrual cycles. And the period of premenstrual symptoms must be followed by a symptom-free period. The symptoms--and there are more than 150 that women may experience--also interfere with her ability to function.
An estimated 20 to 95 percent of all women in their childbearing years experience some premenstrual symptoms. The condition varies from woman to woman and even from one month to the next. But only 3 to 5 percent are said to suffer severely enough to have it interfere with daily living.
"Women with PMS describe themselves as feeling different--not themselves," says Kathleen Hubbs Ulman, Ph.D., an instructor at Harvard Medical School in Boston. "For some, these changes come on slowly, over a day or a few hours. Others say they wake up one morning and feel like a different person." Some women say they want to jump out of their skin. Others are exceptionally sad, slowed down, tired and depressed. They also "feel very irritable," says Dr. Ulman. "It's hard for them to bite their tongues. They're apt to start fights with their husbands or criticize their children more quickly. But those are feelings. Women who feel that way don't have to act on these impulses." With correct diagnosis and counseling, women can work to find ways to experience the feelings without acting on them impulsively and destructively, she says.
The Controversial Condition
Controversy surrounds PMS. While experts agree on the bare essentials of the condition, the complete definition is a matter of opinion. Some prefer to view PMS as consisting of several different subtypes organized around which symptoms women get. PMS-H women are those whose predominant symptoms are weight gain, swelling of the hands, feet and ankles, breast tenderness and abdominal bloating. PMS-A women are those who tend to suffer most with nervous tension, irritability and mood swings. Others designate levels of PMS based on severity and pattern of symptoms. Women with milder symptoms that don't change throughout the cycle fall into a low symptom (LS) category. Those with consistently severe symptoms, such as chronic low mood or irritability, that get even worse premenstrually have a pattern known as premenstrual magnification (PMM). Women with classic PMS have symptoms that are mild or unnoticeable after their periods but that get increasingly worse as their next periods approach.
Another matter of contention is whether PMS should be classified officially as a psychiatric illness. Mild PMS is not included in the American Psychiatric Association's manual of mental disorders. However, PMDD (premenstrual dysphoric disorder), marked by depression severe enough to interfere with daily living, is included in the manual's appendix. According to the American Psychiatric Association, this does not officially designate PMDD as a mental disorder. Opinions over this are divided; some feel that while this classification may help women with severe premenstrual symptoms get the medical help they need, others feel it may stigmatize women by linking mental disorders to the biological process of menstruation.
There's also disagreement over what causes PMS. Theories range from hormone levels to nutritional factors such as lack of Vitamin B6 or magnesium to the impact of fluctuating levels of hormones on brain neurotransmitters such as serotonin and dopamine to psychological factors such as stress.
Why Women in Their Thirties?
PMS tends to appear less often during a woman's teens and early twenties. "I see more women in their thirties, definitely. A lot are even in their early forties," says Marcia Szewczyk, M.D., director of the PMS Clinic at the Bowman Gray School of Medicine of Wake Forest University in Winston-Salem, North Carolina.
And researchers have ideas about why that's so.
One is that PMS is the result of hormonal imbalance--specifically, a drop in the ratio of progesterone to estrogen. Progesterone is believed to have a tranquilizing effect. So the belief is that if the ratio of progesterone to estrogen is too low, increased tension, anxiety and irritability may result.
In addition to this, one of the primary reasons women in their thirties get PMS is that they have a number of opportunities to have hormonal swings, such as pregnancy, miscarriage or going on or off the Pill, says Stephanie DeGraff Bender, clinical director of a PMS clinic in Boulder, Colorado, and author of PMS: A Positive Program to Gain Control and PMS: Questions and Answers.
Other researchers, including Nancy Fugate Woods, Ph.D., of the Center for Women's Health Research at the University of Washington School of Nursing in Seattle, say that stress plays a large role in the development of PMS and that the reason we may see more PMS in women in their thirties and forties is that women's lives tend to get more complex as they get older, says Dr. Fugate Woods. For women between the ages of 30 and 45 today, there are incredible expectations, she says. They may have kids, be supporting their parents, be working two or three jobs or be single parents, she says. "Focusing only on women's biology is to do them a disservice. We need to begin by grounding research in women's lives," she says.
Preventing PMS
Whatever causes it, if you think you have PMS and you're worried about the toll it's taking on your youthfulness--in both mind and body--there are some things you can do to try to keep symptoms to a minimum. Here are some suggestions.
Get up and go. "Women who exercise on a regular basis find that it really does help their PMS," says Dr. Szewczyk. The type of exercise women choose depends on their preferences and fitness levels, she says. Walking, jogging and playing tennis are just a few possibilities. Exercise helps boost endorphins, the body's natural painkillers, so it may help fend off cramps and improve moods. It can also give women a sense of control, says Dr. Szewczyk. There are lots of opportunities to exercise that we often overlook, adds Bender. Simple activities such as taking a walk, riding a bike or turning on a tape player and dancing fast to two or three songs can do the trick, she says.
Cut back on the sweet stuff. Avoid sugar in your diet, says Dr. Szewczyk. This means things such as cookies, candies and chocolate, she says. Keeping your sugar intake low will keep your blood sugar levels from fluctuating wildly. Your energy levels will be more stable, and you'll be better able to cope with whatever discomfort you do have.
Control the caffeine. "I tell people to avoid caffeine," says Dr. Szewczyk. Caffeine stimulates the nervous system, leading to anxiety and mood swings. Women should cut back slowly, basically weaning themselves off caffeinated coffee, she says. One trick that often works is to mix proportions of decaffeinated and caffeinated coffee until you're drinking all decaf, she says.
Shake the shaker habit. Reducing your salt intake can help reduce symptoms of bloating and water retention. Read the food labels carefully. Anything that begins or ends with sodium is a salt, so if there are more than three ingredients with that term, chances are the food is high in salt, says Bender. And watch out for hidden sources of sodium, such as salad dressing, she says. If you have to eat out, opt for vinegar and oil over other dressings whose contents you can't find out.
Reach for calcium. Boosting your calcium intake above the Recommended Dietary Allowance of 800 milligrams (for women over age 24) may help decrease your premenstrual symptoms, researchers say. In a small study of women with PMS, increasing calcium helped decrease mood problems and poor concentration, says James G. Penland, Ph.D., a research psychologist at the U.S. Department of Agriculture's Grand Forks Human Nutrition Research Center in Grand Forks, North Dakota, where the study was conducted. Other studies of women with PMS found similar effects from increasing calcium, he says.
Calcium is thought to play a role in the regulation of some types of muscle, and it also affects neurotransmitters, brain chemicals that may influence mood. Most women consume about 600 milligrams of calcium a day, says Dr. Penland. All they have to do is add one eight-ounce glass of 1 or 2 percent milk and a cup of yogurt, and they'll boost their calcium intakes to about 1,200 milligrams, he says. "The data suggest that if someone experiences unpleasant menstrual symptoms, there may be an immediate benefit from increased calcium intake," he says.
Notice your symptoms. A lot of women say that keeping a symptom diary helps, says Ellen Freeman, Ph.D., director of the PMS Program at the University of Pennsylvania Medical Center in Philadelphia. This helps women see the pattern of their monthly symptoms, she says, which can help them learn to anticipate when they'll feel bad. Women "can be the best experts on their bodies--they can be the best diagnosticians," agrees Dr. Fugate Woods.
Take time to relax. Women with PMS can take advantage of multiple relaxation methods, says Dr. Freeman. These range from "listening to music to doing yoga and meditating to retiring and reading a book," she says. "Whatever works for you is okay." Look for books to get you started, or take a class in relaxation techniques.
Try reflexology. Applying manual pressure to specific points on the ears, hands and feet may relieve some of the symptoms women experience with PMS, says Terry Oleson, Ph.D., chair of the Department of Behavioral Medicine at the California Graduate Institute in Los Angeles who completed the first controlled study of the use of reflexology. Women can perform reflexology on themselves, he says. Press different spots on your ear between two fingers until you find ones that are sensitive, he says. Once you locate them, apply firm but gentle pressure for 30 seconds to one minute, then release. Repeat up to three times if you like.
Address PMS ahead of time. Talk to your partner about having PMS, how it makes you feel, how you might behave, what you're doing about it and what he can do to help, says Bender. Do this at a time of the month when you are symptom-free, she says. Communicating about PMS "needs to be taken care of in non-PMS time," Bender says.
Communicate with your kids. It's important to tell your children that you have a health problem and that you are dealing with it, says Bender. She suggests saying to your child "I have this imbalance in my body, and I'm working on getting it fixed. But when it's there, I may not play with you as much, and I may not talk with you as much. And even though I look the same, I may not be acting the same."
Provide signals to your child about what days your PMS is a problem. For younger children, place smile-face magnets on the refrigerator; on days when you have PMS, turn the smile faces upside down. This lets your child know you're not feeling well. For older children, mark off on a calendar the days you expect to be feeling under par. Bender also recommends telling your children that they can help. Offer to let them help find low-sugar foods, for instance.
Get a diagnosis. While you may think you have PMS, it's necessary to see a doctor to have it officially diagnosed. You will undergo a medical history, physical exam and psychological evaluation and be asked to fill out a symptom diary for three months. Many women who think they have PMS turn out not to when they track their own symptoms, says Dr. Fugate Woods. Women often find that the symptoms correspond to factors other than their menstrual cycles, such as events or relationships in their lives, she says.
