Premenstrual Syndrome (PMS) is the name given to the constellation of symptoms that plague women for about a week before “that time of the month” and ease up shortly after the menstrual flow begins. It-s estimated that PMS affects 80% of all premenopausal women, but I can-t remember ever meeting one who didn-t feel at least a little “different” during those few days before the onset of her period. Some suffer from it very much, others hardly at all. It is most troublesome between the ages of 25 and 40. It never occurs before menarche (the first menstrual period), during pregnancy or after menopause.
At least 150 different symptoms have been attributed to premenstrual syndrome, many of which are emotional or behavioral. Typically, a few days before her period, a woman becomes depressed, moody, tense, angry or just plain ornery- for no apparent reason. She loses interest in activities she normally enjoys. She may be unable to concentrate and is worn out yet unable to sleep. In 5% of cases, the depression and/or rage is extremely debilitating. This is termed “premenstrual dysphoric disorder” (PMDD).
Common physical symptoms of PMS include aches and pains in the muscles and joints. There may be bloating and weight gain due to fluid retention. The breasts become swollen and tender, and headache is also common. And, for some reason, almost every woman I know craves sweets–especially chocolate during those few days of PMS.
Don-t blame the hormones. It formerly was assumed that women with severe symptoms had a different hormonal profile than those who breeze through that week with never a complaint. Accordingly, the most popular therapies–until now–were focused on modifying these hormonal patterns by adding a little progesterone or some estrogen. This therapy never worked, and so other approaches were tried–notably vitamins and herbs. Although they sometimes help, they haven-t been entirely satisfactory either.
In a landmark study directed by Dr. Peter J. Schmidt of the National Institute of Mental Health, women with no symptoms of PMS were compared with women who were severely debilitated by it. In both groups, hormone production was first suppressed, and then hormones were given in similar doses over a period of weeks. Although the women with PMS reported increased symptoms, those without PMS reported no change in mood or any other symptoms. In other words hormonal change makes no difference in some women and therefore is not likely to be the cause of PMS. So what is the cause?
The brain! Every month, in response to the normal hormonal fluctuations in the menstrual cycle, chemical changes occur within the brain. For example, there is a reduction in the level of an important mood-altering chemical called serotonin. This lowered serotonin accounts for most of the emotional and behavioral changes of PMS, and one of the newer ways to treat it is to prescribe drugs that restore normal levels of serotonin. In those few days before the period begins, the adrenal glands that sit atop the kidneys, responding to signals from the brain, make too much aldosterone, a hormone that causes the body to retain salt. Hence the fluid retention, bloating and weight gain.
The craving for sweets probably reflects fluctuations in insulin production and sugar levels.
What can you do to get relief? Here are some suggestions with a track record of effectiveness:
- Do regular aerobic exercise. Walk, jog, swim or bike 20-60 minutes a day, five days a week. This alleviates PMS by stimulating the brain to produce endorphins–opiate-like chemicals that confer a sense of well-being. Exercise also helps remove excess body fluid.
- Reduce your salt intake. The increased amounts of aldosterone already are making your body saltrich.
- Avoid concentrated sweets. They stimulate the pancreas to make more insulin, which in turn causes the blood sugar level to fall, leaving you weak and dizzy. If you simply must have chocolate, break a small piece off a bar and hand the rest to your mother-in-law.
- Chances are that, with a little will power, you-ll be able to control the desire to eat more of what you-ve given away.
- Don-t go without eating for more than three hours. You-ll be too hungry to control your craving for sweets. Forget about three regular meals a day during the time when you-re vulnerable to PMS. Have five or six smaller meals and snacks throughout the day, preferably complex carbohydrates-such as bread, pasta, cereal, whole grains and potatoes–as well as fruit and leafy green vegetables. These foods don-t cause a drop in sugar levels and may even increase the amount of mood-elevating serotonin in the brain.
- Don-t use alcohol, tobacco or caffeine (coffee, tea, soft drinks) for the duration of PMS. Caffeine increases the desire for sweets, and more than three cups a day can leave you feeling nervous and intensify your emotional symptoms. Alcohol and tobacco also can aggravate mood swings.
- Drink at least six large glasses of water every day, even though you-re retaining fluid. Without added salt, the water will be excreted.
- Learn biofeedback and other stress-reduction techniques. These include the Relaxation Response (described in Dr. Herbert Benson-s book of the same title), yoga, taichi and guided imagery. They all reduce stress.
- Get more natural light. Some people become depressed in the fall and winter, when the days shorten and there is less natural light – a condition called Seasonal Affective Disorder (SAD) – and they respond to increased exposure to light. There is some evidence that light also helps PMS. Go for a walk during the day, even if it-s cloudy outside.
- Recent articles have suggested that increasing calcium intake and eating a vegetarian diet during the last two weeks of each menstrual cycle can reduce symptoms.
What can you take? The key element in treating PMS is taking something that will correct the chemical changes in the brain. This includes:
- Antidepressants of the type known as “selective serotonin reuptake inhibitors” (SSRIs), which increase brain serotonin levels. My favorite is Zoloft; other doctors prefer Paxil or Prozac. But before you take any of these prescription drugs, I suggest you try St. John-s Wort, an herbal preparation available over the counter at any pharmacy or health-food store. It-s not as strong as the SSRIs, but it has fewer side effects and is often all you need. The usual dose is 300mg three times a day.
- Prescription anti-anxiety drugs such as Xanax or BuSpar, taken for several days before your menses will make you feel better too.
- Vitamin B6 (pyridoxine). It works by increasing serotonin levels in the brain, although not everyone benefits from it. Take 50mg to 250mg a day.
And for those aches and pains:
- Vitamin E supplements (400-800 I.U. per day) may help reduce breast tenderness.
- Magnesium, sometimes called the “antistress mineral,” helps relieve depression and fatigue. Doses up to 250mg per day reduce the craving for sugar and also may ease breast tenderness.
- SAID medication, such as Advil, Aleve and Motrin – available without a doctor-s prescription – help relieve muscle and joint aches and pains. For those few days when women experience troublesome bloating and fluid retention, I prescribe a mild diuretic, such as 25mg of hydrochlorothiazide. Some doctors recommend oral contraceptives for PMS. I have never seen them work. Another popular therapy is progesterone, the sister hormone to estrogen, taken by mouth or vaginally. As with contraceptive pills, however, there is no rationale for its use and no convincing evidence that it has any beneficial effect.
If you suffer from PMS, you-re not alone – and you-re not a mental case. Your symptoms are due to chemical changes in the brain that are now better understood than ever before. The suggestions I-ve made to modify them should help.
By Dr. Isadore Rosenfeld. Reprinted from Parade Magazine 2/13/2000. Edited by Dr. John Woodward
YOUR GUIDE TO RELIEF
The following suggestions, detailed in this article, can ease many of the symptoms of PMS.
- Exercise, Regular aerobics-20 minutes to an hour, five days a week- is best.
- Reduce your salt intake.
- Avoid concentrated sweets, especially chocolate.
- Avoid alcohol, tobacco and caffeine (coffee, tea, soft drinks).
- Vegetarian Diet
- Drink at least six large glasses of water every day.
- Learn biofeedback and other stress-reduction techniques.
WHAT YOU CAN TAKE
Available by doctor-s prescription:
- Estradiol Pellets
- Antidepressants (Zoloft, Paxil, Prozac).
- Anti-anxiety drugs (Xanax or BuSpar),
- Take 12 days before menses.
- A mild diuretic.
Available over the counter:
- St. John-s wort (for depresssion.
- Vitamin B6 (pyridoxine).
- Vitamin E and magnesium supplements.
- NSAID pain medications (Advil, Aleve, Motrin).