For three weeks out of every month you’re energetic, happy, upbeat and even-
tempered, then it happens. A week before your period begins the change into a
“mad women” happens. Your mood swings form frustration to irritability, to
downright anger, even depression. Your breasts become tender to the touch, and
your ankle, feet, hands and stomach swell so much that your clothes become to
tight it’s uncomfortable to move. Somehow, despite the cramps and the
headaches we manage to waddle to and from the refrigerator to satisfy those
“junk food cravings”. Sounds awful? It is but it’s something that we as
women deal with on a monthly basis. The dreaded is known as Premenstrual
Syndrome or PMS. Premenstrual Syndrome is also known as premenstrual tension,
premenstrual dysphoria and most commonly PMS. PMS is a symptom or collection of
symptoms that occurs regularly in relation to the menstrual cycle, with the
onset of symptoms 5 to 11 days before the onset of menses and resolution of
symptoms with menses or shortly thereafter (Yahoo 1). Another source describes
PMS as a disorder characterized by a set of hormonal changes that trigger
disruptive symptoms in a significant number of women for up to two weeks prior
to menstruation. Of the estimated forty million sufferers, moor than five
million require medical treatment for marked mood and behavioral changes. Often
symptoms tend to taper off with menstruation and women remain symptom-free until
the two weeks or so prior to the next menstrual period. These regularly
recurring symptoms form ovulation until menses typify PMS (Lichten 1). The
symptoms that can occur are many. The most common physical symptoms can include
headache, swelling of ankles, feet and hands, backache, abdominal cramps or
heaviness, abdominal pain, abdominal fullness, gaseous muscle spasms, breast
tenderness, weight gain, recurrent cold sores (herpes labialis), acne flare-up,
nausea, bloating, bowel changes (constipation or diarrhea), decreased
coordination, food cravings, decreased tolerance to sensory input like noise and
light, and painful menstruation. Other symptoms not physical can include
anxiety, confusion difficulty concentration, forgetfulness, poor judgment,
depression, irritability, hostility, aggressive behavior, increased guilt
feelings, fatigue, decreased self image, libido changes, paranoia, lethargic
movement low self-esteem (Yahoo 2). The symptoms are obviously many and have a
varying degree of severity. The next question that arises is what the cause
could be. The exact cause of PMS, headaches and depression are unknown. In fact,
it is not known why some women have severe symptoms, some have mild ones, while
others have none. It is generally believed that PMS patients, migraine and
depression come from neurochemical changes within the brain. Hormonal factors,
such as estrogen levels, may also be the cause. The female hormone estrogen
starts to rise after menstruation and peaks around mid-cycle. It ten rapidly
drops only to slowly rise and then fall again in the time before menstruation.
Estrogen holds fluid and with increasing estrogen comes fluid retention; many
women report weight gains of five pounds premenstrually. Estrogen has a central
neurological effect: it can contribute to increase brain activity and even
seizures. Estrogen can also contribute to retention of salt and a drop in blood
sugar. PMS patients benefit from both salt and sugar restriction (Lichten 2).
Another possible cause dates back almost sixty years. In the psychoanalytic
essay on PMS by Karen Horney, she suggested that the tension preceding the
period is caused by the unconscious denial of a desire for a child. In 1942 the
first extensive psychological tests conducted on menstrual and premenstrual
women. “Therese Benedek an d B.B. Rubenstein examined the emotional an
hormonal swings of the menstrual cycle and found a tendency toward acute
emotional response and dependent behavior during the premenstruum, which they
attributed to changes in the production of estrogen an d to certain
psychological factors. Since 1942, many attempts have been made to evaluate the
premenstrual symptoms, but psychologist Mary Brown Parlee later concluded that
there is no established proof that a measurable PMS even exists. The co
relational studies and the Premenstrual Distress Questionnaire results of Moos
in 1968 often predict, through their wording, the very symptoms that they expect
to isolate. Most of the studies on violence and PMS fail to place women in
appropriate subgroups. And in almost every case that involves proving PMS, a
nonmenstruating control group is absent. Parlee suggests, as do Lennane and
Lennane, that menstrual dysfunctions are more likely to have physiological that
psychological origins (Delaney et al. 71). PMS may be able to be prevented by
making some lifestyle changes. These can include regular exercise 3 to 5 times
per week and a balanced diet. The exercise is important because it reduces
stress an tension, acts as a mood elevator, provides a sense of well-being and
improves blood circulation by increasing the natural production of beta
endorphins (Mayoclinic 2). The diet should include increased whole grains,
vegetables, fruit, and decreased or no salt, sugar, alcohol, and caffeine. Daily
supplemental vitamins and minerals may be administered to relieve some PMS
symptoms. S multivitamin with B6 (100 mcg), B complex, magnesium (300mg),
Vitamin E (400 IU) and vitamin C (1000 mg) may be recommended to alleviate
irritability, fluid retention , joint aches, breast tenderness, anxiety,
depression and fatigue (Lichten 2). Recognizing that the body may have different
sleep requirements at different times during a woman’s menstrual cycle is also
important. The importance of recognizing sleep requirements is because there is
often increased activity prior to the worse symptoms of PMS. At this time, the
woman may clean the house, function with little sleep, and feel euphoric. This
is followed by the PMS symptoms, fatigue, exhaustion, depression and the
inability to function. Women typically feel “out of control” at this time
and this can cause the signs and symptoms of depression. Therefore it is
important to get proper rest (Lichten 3). There are no physical examination
findings or lab tests specific to the diagnosis of PMS, although a thyroid test
may rule out a thyroid condition that looks like PMS (St. Lukes 1). It is
important that a complete history , physical examination (including pelvic
exam), and in some instances a psychiatric evaluation may be conducted to rule
out other potential causes for symptoms that may be attributed to PMS. It is
also important to maintain a daily diary or log to record the type, severity,
and duration of the symptoms. A “symptom diary” should be kept for a minimum
of three months in order to correlate symptoms with the menstrual cycle. The
diary will greatly assist the health care provider not only in the accurate
diagnosis of PMS, but also with the proposed treatment symptoms. Complications
may also occur. PMS symptoms may become severe enough to prevent women from
maintaining normal function. Women with depression may note increasing severity
of symptoms during the second half of their cycle and may require associated
medication adjustments. The incidence of suicide in women with depression is
significantly higher during the latter half of the menstrual cycle. Because of
the severity that PMS can reach there are various treatments that have developed
through the years (Yahoo 3). There are various treatments for PMS and they may
differ according to the individual and severity. Since 1953, hormonal therapies
have been the main treatment. Kathrina Dalton, M.D., a family practitioner in
England, evaluated the effectiveness of a program of aqueous progesterone
suppositories on her own symptoms. When they were relieved, she repeated the
study with 50 patients under the care of a leading gynecologic endocrinologist.
They also experienced improvement. These aqueous progesterone suppositories have
been found effective. They are safe during pregnancy, and can be used well into
menopause. Since 1979, Day and others have reported on the use of low dose
Danazol to control the worst PMS. Danazol is taken all month long and prevents
the rise and fall of estrogen level. In more than 10 medical articles, the
success rate for controlling PMS in more than 80 percent. Although Danazol has
the side effects in some of acne and fluid retention, most are easily treated.
Rarely have there been liver or bone changes with these dosages of medication.
Some patients are so will controlled on hormonal therapy that they are able to
discontinue the medications prescribed by the psychiatrist. SSC Yen in 1985
showed that luprolide acetate, a long-acting agent for endometriosis, can
rapidly eliminate the worse PMS symptoms (Lichten 3). Another treatment is oral
contraceptives. Oral contraceptives stop ovulation so PMS symptoms usually are
relieved. The newest oral contraceptives are very low-dose, so there are few
side effects. Prostaglandin inhibitors, such as aspirin and ibuprofen, may be
prescribed for women with significant pain, including headache, backache,
menstrual cramping and breast tenderness. Diuretics may be prescribed for women
found to have significant weight gain due to fluid retention. Menopause is also
a cure for PMS (Mayoclinic 3). The most important thing to know is that the pain
and mood swings are real. Women need not feel that they are “going crazy”
for these two weeks every month. They are experiencing an exaggeration of normal
function, for which there is treatment.