Health Concerns - PMS
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Premenstrual Syndrome (PMS)

Premenstrual Syndrome (or PMS) has been a recognized condition since ancient times, with scholars such as Aristotle having written on the subject. A woman afflicted with PMS may experience a wide variety of seemingly unrelated symptoms. For that reason, it may be difficult to diagnose. In general, a women with PMS usually has a cyclical pattern to her symptoms. It has been estimated that 85% of menstruating women report one or more symptoms of PMS, less than 10% of women experience symptoms severe enough to affect quality of life. However, of the estimated 40 million suffers, more than 5 million require medical treatment for marked mood and behavioral changes. Symptoms and discomfort level vary from woman to woman, but PMS affects women from all cultures and socioeconomic levels.

What Are the Symptoms of PMS?
Symptoms vary from woman to woman. Over one hundred symptoms have been observed, with each woman reporting her own unique set. They come in many combinations, ranging in severity from mild to moderate to incapacitating.

Emotional related symptoms include: depression, easy crying, fatigue, anxiety, irritability, and unexplained anger.

Other symptoms are related to physical symptoms and include: migraine headaches, swelling and bloating, breast tenderness, abdominal cramping, acne, cravings for sweet or salty foods, and weight gain.

Lastly, other conditions may worsen premenstrually. Some women notice worsening irritable bowel problems, seizures, migraines, and asthma. New data has revealed that the symptoms of irritable bowel syndrome (IBS) are worsened by menses. The researchers found that menses were associated with worsening of abdominal pain and bloating compared to other phases of the menstrual cycle.

Of all PMS sufferers, 3-5% of women have symptoms that are so severe that they cannot function in their normal day to day routines. These women are classified as having the premenstrual dysphoric disorder (PMDD).

When does PMS occur?
Symptoms appear five to seven days before the onset of the period and subside with flow. Alternatively, symptoms may begin at mid cycle (or ovulation) and last approximately two weeks or until menstrual flow begins. A woman with PMS usually has at least five days a month free of PMS symptoms.

Due to the hormonal fluctuations of the perimenopause, numerous symptoms common to PMS and PMDD may occur for the first time or actually worsen.

What causes PMS?
Doctors and scientists have searched long and hard for the cause of PMS, and unfortunately it has not yet been found. However, the most current theory involves abnormalities of the brain chemical serotonin and the female hormones, estrogen and progesterone.

Before treating PMS, a patient should identify the symptoms that are most prominent and troublesome. This is best done by way of ‘menstrual charting’. It is recommended to chart your own set of symptoms on a calendar for two months.

Current recommendations include getting enough rest, exercising each day, and eliminating or modifying salt, sugar, caffeine, and alcohol intake. Exercise is helpful for PMS because it reduces stress and tension, acts as a mood elevator, provides a sense of well-being and improves blood circulation. A complex carbohydrate diet has been advocated by the American College of Ob/Gyn.

Daily supplemental vitamins and minerals may be administered to relieve some PMS symptoms. Calcium supplementation has been proven to reduce a number of PMS symptoms. 1000 to 1500 milligrams per day is recommended. A B-complex vitamin has been advocated for some women with PMS, although not conclusively proven beneficial in scientific studies.

Despite that detailed studies have not conclusively shown a benefit for PMS sufferers, natural progesterone creams have been used by many. The rationale behind the use of progesterone cream is the probable link between estrogen and progesterone levels in PMS. By supplementing progesterone during the premenstrual time, a leveling of the hormonal milieu may occur and offer relief of symptoms.

Serotonin selective reuptake inhibitor (SSRIs) antidepressants have been shown effective and may be useful for severe PMS. Alprazolam, an antianxiety medication, may be potentially useful for some women with severe symptoms, but should be carefully considered due to side effects and possible addiction.

The herb Vitex agnus castus (Chaste Tree Berry) has shown promising benefit in treating PMS. A recent study in the British Medical Journal evaluated the use of Chaste Tree berry (Vitex agnus castus) in women with premenstrual syndrome. They evaluated 170 women with PMS. The main outcome measures included women's self-assessment of irritability, mood alteration, anger, headache, breast fullness, and other menstrual symptoms including bloating.

The results showed a statistically significant improvement in the main outcome measures compared to placebo. No women discontinued the trial due to adverse effect. The authors concluded that 'dry extract of agnus castus fruit is an effective and well tolerated treatment for the relief of symptoms of the premenstrual syndrome'.

Gonadotropin-releasing hormone (GnRH) agonist treatment to prevent ovulation has been shown to be useful, but the long-term side effects and cost limit its use to those women with severe symptoms who are unresponsive to other treatments.

Oral contraceptives have been widely prescribed as a treatment for PMS, but there is little data to support their effectiveness. Approximately one third of patients will show improvement, while 2/3 will show no benefit and potentially worsening of symptoms. However, a new oral contraceptive has shown promise for PMS sufferers. Further studies for PMS are being done on this contraceptive that contains a diuretic component called drosperinone.

Spironolactone is a diuretic that has shown a benefit for fluid-retention.

Therefore, PMS and PMDD are very common problems. Identifying the potential problem, prospective charting of symptoms and seeking a compassionate health care provider are important to plan a treatment regimen. Optimizing dietary measures (including calcium intake); limiting alcohol, caffeine and tobacco use and improving exercise are very simple measures that are a good starting point for any woman concerned about PMS.

The information provided by MenopauseRx, Inc. is not intended to replace the medical advice of your doctor or health-care provider. Please consult your health-care provider for advice about a specific medical condition.