PMS -- It's NOT Just in Your Head

Vickie W. Lovin, M.D.

Most women have experienced some form of premenstrual tension at some time in their lives. It may involve minor irritability or it may be a debilitating condition which can precipitate work-related problems, marital problems, child abuse or even suicide.

For years it was felt that these premenstrual complaints were psychological in nature, or that this was just part of being a woman, or worse, just an excuse to be mean and nasty. However, today most physicians understand that the symptoms of PMS, both the physical and psychological, are real. Even though we do not know the exact cause, they are felt to be related to a woman's hormone levels.

What is PMS? By most definitions PMS is a combination of both physical and emotional symptoms occurring one - two weeks prior to menstruation and improving dramatically at the onset of bleeding. The physical symptoms include such things as swelling, bloating, headaches, diarrhea or constipation, abnormal cramping, aching muscles and joints, nausea, fatigue, breast tenderness and backache. Emotional symptoms are often even more prominent than the physical ones, and include irritability, anxiety, depression, anger, mood swings, inability to concentrate and paranoia.

The symptoms can be mild and annoying or can be incapacitating. Either way, women should be reassured that the symptoms they are feeling are real, they have a cause, and there is help.

How is PMS diagnosed? Since most women have some of these symptoms at times it is important to differentiate PMS from other medical or emotional problems. The obvious way to do this is to have the patient keep a diary for two to three months and to record her symptoms on a daily basis. If they always occur the week prior to her period and disappear as soon as bleeding begins then the symptoms are probably related to PMS. Symptoms that occur off and on throughout the cycle are probably not PMS. Symptoms which are present all month but just get worse premenstrually are not PMS.

Many patients ask that we order a blood test to diagnose what is wrong with them, but at this time there is no blood test that is diagnostic. In order to come up with a diagnosis you should see a physician and discuss your history and symptoms. You should keep a diary of your symptoms for several consecutive months and you should have a complete physical exam and blood work evaluation to rule out other causes.

What can be done about PMS? If your symptoms are fairly mild you may be able to minimize them yourself by such things as eating properly, exercising and taking various vitamin, mineral and herbal supplements. Dietary alterations include such things as avoiding caffeine, alcohol, excess salt, sugar and fat, while increasing your intake of complex carbohydrates, fruits, vegetables and whole grains. Vitamin E, Vitamin B6, Evening Primrose Oil (EPO), Calcium and Magnesium have all been found to be helpful and are recommended to any PMS sufferer in the following doses:

Vitamin E: 400 miu/day
Vitamin B6: 50 - 100 mg/day
Calcium Citrate: 1,000 mg/day
Magnesium Oxide: 500 mg/day
Evening Primrose Oil: 2 - 6 capsules/day

But most importantly, you should try to exercise 30 - 40 minutes 3 -5 times weekly. This may be the best treatment we have for mild to moderate PMS.

What if these things don't help? If you have tried nutritional adjustments, exercise, and vitamins and minerals, and you still suffer greatly, there are numerous medications which can be prescribed depending on which symptoms are the most prevalent. If depression and irritability are prominent symptoms, antidepressants such as Prozac® can be extremely helpful. A lot of women are very hesitant to take antidepressants because they are concerned about side effects or becoming dependent on them. However, the side effects from the newer antidepressants such as Prozac® are usually minimal and include nausea, diarrhea, dry mouth, insomnia, weight loss or weight gain and either decreased or increased libido. Most people do not experience anything significant and if they do, it usually subsides within 1 - 2 weeks. As for being dependent, there is no evidence that antidepressants are addicting. Needless to say, however, these would only be prescribed in severe cases where more conservative treatments have not worked, and in these cases mild side effects are a small price to pay for the tremendous relief they provide.

For more moderate cases of PMS, mild tranquilizers, and/or a mild diuretic are sometimes used on an as needed basis. These are just some of the treatments we use, with each case being individualized. Rarely there can be an indication for a hysterectomy if all treatments fail. Prior to recommending this, we might recommend another medication which suppresses hormone production from ovaries. When we use this medication, called Depo-Lupron®, it can tell us ahead of time whether a patient will do well if her uterus and ovaries are removed. If the patient feels well while on the Depo-Lupron® chances are she will do well after surgery. However, this is reserved for the most severe, unrelenting cases.

If you suffer from PMS, hopefully, you can find some relief from one of the above suggested treatments. Realize that you are not alone, you are not crazy, and you can get help.

A Woman's View
915 Tate Blvd. SE
Suite 170
Hickory, North Carolina 28602
(828)345-0800