Premenstrual Syndrome
Premenstrual Syndrome
No Two Experiences Are Alike
Your breasts are tender, you feel bloated and achy, and your head's pounding something awful. You're also edgy and irritable. Actually, you're more than irritable. Your friend is going to be five minutes late for lunch--something that doesn't usually faze you, but today you're downright furious. If she doesn't hurry up and get here, you'll really let her have it.
You never used to feel this way. But lately the two weeks just prior to your period have been a struggle. Last month there were several days when you were in a bad mood before your feet even hit the floor in the morning. It felt like a black cloud was following you around. The month before that you felt anxious and edgy, like you wanted to jump out of your skin. Yesterday you snapped at your husband over a rather minor matter. And today you feel like you're going to lose it with your friend.
Could this be PMS? Well, maybe.
The Problem of Definition
The term PMS has come to mean a lot of different things. If you mean premenstrual symptoms, like bloating or moodiness, that's one thing. Up to 90 percent of women in their childbearing years experience some premenstrual symptoms, of which there are over 150. In fact, the thirties and forties are often when symptoms first develop. It's also a time when they tend to get worse if you already had them. So there's a good chance you have premenstrual symptoms.
Premenstrual syndrome (PMS), on the other hand, is something more severe. Fewer women--between 3 and 5 percent--are thought to suffer from it.
PMS differs from milder premenstrual discomfort in that its symptoms are severe enough to interfere with a woman's personal, social and work life. Its symptoms occur regularly. That is, instead of occurring randomly--a month here and a month there--they occur frequently, in at least two out of every three menstrual cycles. Symptoms tend to appear somewhere between ovulation and the beginning of a period. And the time span when symptoms occur is followed by a time--usually the two weeks right after the start of a period--when the woman is symptom-free.
Whether you have premenstrual symptoms or PMS, you may be wondering what causes your feelings and behavior to shift in the two weeks before your period. That's hard to say exactly, but there are lots of theories.
Some researchers suspect that the mood changes and emotional shifts are related to the levels of progesterone and estrogen, reproductive hormones whose levels rise and fall during the menstrual cycle. The thinking is that the increased tension, anxiety and irritability of PMS may be due to a low estrogen-to-progesterone ratio. That is, levels of progesterone, a hormone believed to have a tranquilizing effect, may be lower than estrogen levels, and anxiety results.
Women in their thirties and forties are more likely to have been on and off the Pill or have gotten pregnant, and these hormonal changes may be what triggers the hormone shifts and the development of PMS, says Stephanie DeGraff Bender, director of the PMS Clinic in Boulder, Colorado, and author of PMS: A Positive Program to Gain Control.
Another theory is that PMS symptoms arise from shifting levels of neurotransmitters, the special brain chemicals believed to influence mood. In particular, the chemicals serotonin, norepinephrine and dopamine are thought to be involved. The change in neurotransmitter levels may be tied to changes in estrogen and progesterone levels, but just how isn't exactly clear.
There are also some indications that nutrition may play a role. In particular, magnesium, riboflavin, vitamin A, calcium and manganese deficiencies may contribute to the exacerbation of symptoms.
Stress may also play a role in the development of PMS and may be another reason that women tend to develop PMS in their thirties and forties. Women past 30 have more complex lives, says Nancy Fugate-Woods, Ph.D., of the Center for Women's Health Research at the University of Washington School of Nursing in Seattle. These women often have children or are working full time, or both. They may be single parents or supporting their parents, she says. They have a lot more stress at this phase of their life than they did when they were younger, and the development of PMS may be somehow related to that, she says.
The Link to Menopause
Some women find that their PMS gets markedly worse just before menopause, says Ellen Klutznick, Psy.D., a psychotherapist in San Francisco who counsels menopausal and perimenopausal women. And some experts say it can be a sign that a woman has entered perimenopause, the stage in which estrogen levels start to decline, women's periods begin to change, and menopausal problems like hot flashes, mood swings and weight gain arise. Just because you develop PMS doesn't mean you're entering menopause, but if your symptoms get markedly worse, that can be a sign, and it can't hurt to have your hormone levels checked, says Dr. Klutznick.
Living with PMS
Premenstrual syndrome can really take its toll on the women who have it.
Mood symptoms tend to be most troublesome, experts say. "The symptoms women are really concerned about are depression, anxiety, anger, sleeplessness and hopelessness," says Annette Rossignol, Sc.D., professor and chair of the Department of Public Health at Oregon State University in Corvallis. It's hard to say whether these are the symptoms women get most, but they are the ones for which they seek help most often, she says.
These emotional changes can affect relationships. Women may find themselves feeling and behaving differently. They may lose control with a friend or snap at a co-worker or at their children, says Bender. Then, feeling guilty afterward, they resolve not to let something similar happen the next month. But often it does, and the guilt over their behavior, combined with their failed attempts not to repeat it, causes their self-esteem to plummet, she says.
The impact of PMS can extend beyond the women themselves. "PMS is not just a woman's issue," says Dr. Rossignol. "It's a family issue." Often a woman's change in behavior can be difficult or confusing to partners and children. One month the kids may find Mom more than happy to have the whole softball team over, while the next month she snaps at the mere mention of the idea, explains Bender. And spouses may find their partners getting upset over things that never seemed to bother them before.
Finding Relief
Whether you suffer from premenstrual symptoms or PMS, there are some things you can do to make the two weeks prior to your period a little easier. Here are some suggestions.
Keep a symptom diary. The first step in figuring out whether you have PMS is to start charting your symptoms. "Any expert will say you have to sit down and, for three or four months, document what you are experiencing on a day-to-day basis," says Suzanne Trupin, M.D., head of the Department of Obstetrics and Gynecology at the University of Illinois College of Medicine at Urbana-Champaign.
The idea is to track your symptoms to see if they occur in the latter half of your menstrual cycle. If they do, that's a clue you may have PMS. If your symptoms occur throughout your cycle, you may have some other health problem. If you have a lot of different symptoms and it's overwhelming to chart them all, "pick the top three symptoms that bother you the most and chart those," says Dr. Trupin.
Cut back on caffeine. Caffeine is a stimulant to the nervous system and can contribute to mood swings, feelings of anxiety, nervousness and edginess. Women with premenstrual symptoms and syndrome often find that cutting back on caffeine helps decrease anxiety. Aim to cut back a little at a time, says Dr. Trupin. "Progressively add decaffeinated coffee to your caffeinated till you're drinking all decaf," she says. It's unrealistic to think you can do it all in just a few weeks, she says. It may take a few months.
If you drink caffeinated soda, try the same thing: Mix decaffeinated soda with the caffeinated a little at a time until all you're drinking is decaf.
Stay active. Exercise is very important for women with premenstrual symptoms or syndrome, says Marcia Szewczyk, M.D., assistant professor in the Department of Family and Community Medicine and director of the PMS Clinic at the Bowman Gray School of Medicine in Winston-Salem, North Carolina. "I encourage women to go out and do regular walking or jogging or to play tennis," she says. Exercise can help boost your mood because it stimulates the release of endorphins, the body's natural mood elevators.
Desalt yourself. If bloating and water retention are major problems for you, try reducing your salt intake, experts say. Read food labels and look for ingredients that include the word sodium. And keep an eye out for high-salt foods when you dine out. Salad dressings in particular can be high in salt, so try opting for oil and vinegar.
Watch what you eat. Fluctuating blood sugar levels can cause your energy level to swing up and down, making it harder to cope with any premenstrual symptoms you have, says Dr. Szewczyk. Maintaining a steady blood sugar level can make coping easier. So "eat frequent small meals," she says, and avoid sweets like cookies, candy and chocolate.
Go for calcium. Getting more calcium in your diet may help decrease premenstrual symptoms, according to researchers at the Grand Forks Human Nutrition Research Center in North Dakota, part of the Agricultural Research Service at the U. S. Department of Agriculture. Calcium is believed to affect levels of hormones and neurotransmitters.
In a small study of women with premenstrual symptoms but not PMS, mood problems such as depression, anxiety, tension and loneliness were reduced when women increased the calcium levels in their diets, says James G. Penland, Ph.D., research psychologist at the Grand Forks center. Water retention, pain and concentration problems were also somewhat alleviated. Women with PMS may also benefit.
So aim to get at least 1,200 milligrams of calcium each day, says Dr. Penland. Two eight-ounce glasses of 1 percent milk (about 300 milligrams each) and one cup of low-fat yogurt (about 415 milligrams) will bring you close to what you need.
Put your cravings on hold. When you get a craving for sweet foods--the cookies, candy and cake--try to put it off for half an hour, says Dr. Rossignol. You may change your mind about whether you really have to have them, she says.
Put some pressure on. Try reflexology, a technique that involves applying manual pressure to specific areas of the ears, hands and feet. According to Terry Oleson, Ph.D., chair of the Department of Behavioral Medicine at the California Institute in Los Angeles, the first study on reflexology indicates that applying manual pressure to specific pressure points on the ear, hand or foot may relieve some of the symptoms women experience with PMS.
Applying pressure to points on the upper half of the ear tends to relieve symptoms in the lower half of the body, while pressure to the lower half works on the upper half of the body, for headaches. While trained reflexologists are available to perform the technique, women can try it on themselves, says Dr. Oleson. Gently pinch your ear between two fingers until you find a sensitive spot, he says. Once you locate one, gently apply pressure with the two fingers for 30 to 60 seconds, then release and repeat up to three times if you like, says Dr. Oleson.
Communicate your troubles. Find time when you do not have symptoms to talk with your partner about your premenstrual experience, says Bender. Changes in your moods and behavior can be confusing and even hurtful, and talking about what's happening may help him understand. Tell your partner how PMS makes you feel, how you might behave, how he can help you and what you are doing to address it, she says.
Share with the kids. Premenstrual syndrome can be confusing to children, too, says Bender. Tell your kids that you have an imbalance in your body that may cause you to act different at times, she says. For younger children, try hanging a smiley face magnet on the fridge and use it to communicate how you're feeling, says Bender. On "PMS days" simply turn the magnet upside down. Kids usually get the picture, she says.
Get help. If you can't get your premenstrual symptoms under control on your own, seek medical help. A doctor will take a medical history, do a physical exam and psychological evaluation and ask you to fill out a symptom diary for three months in order to diagnose you.
