PREMENSTRUAL SYNDROME

 The following information has been summarized from the latest medical research on PMS and includes a general outline of the symptoms, possible causes and current management of symptoms.  As with any medical condition, it is important to discuss your individual symptoms and needs with your physician before beginning any treatment plan.

WHAT IS PMS?
Premenstrual Syndrome (PMS) is a complex disorder characterized by a wide range of symptoms that occur regularly before menstruation and then stop at the onset of the menstrual cycle in a cyclic pattern.  Characteristically, physical and emotional symptoms occur 3 to 14 days before menstruation and cease with the menstrual period.  Many symptoms have been associated with PMS. Although many theories have been developed to explain PMS, the exact cause is still unknown.  As a result, medical treatment is designed to control symptoms rather than cure the condition.

WHAT IS PMDD?
PMDD or Premenstrual dysphoric disorder is a severe type of PMS.  Symptoms of PMDD may include: feeling hopeless or sad, tense, anxious, frequent crying, constant irritability and anger that cause conflict with other people, lack of interest in things you used to enjoy, and difficulty concentrating.

WHAT ARE PMS SYMPTOMS?
Psychological Changes: 
Anxiety, irritability, depression, restlessness, hostility, confusion, crying, mood swings, nervous tension, depression, forgetfulness, confusion, insomnia

Physical Changes:
Fatigue, insomnia, headache, abdominal bloating, weight gain, breast tenderness, water retention leading to swelling of hands and feet, intestinal bloating, constipation, headache, fatigue, dizziness, fainting, lethargy, acne, lack of coordination, and clumsiness.

Food Cravings:
Increased appetite, increased thirst, craving for sweets, especially chocolate, craving for salty foods and alcohol

HOW LONG DOES PMS LAST?
Symptoms may be experienced from one to 14 days prior to the beginning of menses. To diagnose PMS, the symptoms must be present in the 5 days before a period at least three cycles in a row.  The symptoms must end within four days after the period and interfere with normal activities. In rare cases, they may begin as long as three weeks before menses.  As soon as menstruation starts the symptoms usually cease. Many women notice PMS is worse during their 40’s.  Anxiety and depression disorders are commonly misdiagnosed as PMS.  If symptoms do not go away once the cycle starts, they are treated differently.  Some women may have both depression and PMS.

HOW MANY WOMEN DOES PMS AFFECT?
More than 40 percent of women in the United States suffer from one or several symptoms with 5 to 10 percent being severely affected.

WHAT CAUSES PMS?
Despite extensive research that is currently being done on PMS, the exact cause remains unknown.  The following factors may be predisposing events leading to PMS: women over age 30, stress, poor eating habits, lack of exercise, puberty, childbirth, tubal ligation, hysterectomy, discontinuance of birth control pills. Many women mistakenly attribute their symptoms to menopause.

HOW IS PMS DIAGNOSED?
At the present time there are no specific tests that can be done to diagnose PMS.  The most effective way to determine if you have PMS is to keep a chart or log of your symptoms.  The most important thing to note is when the symptoms occur and the presence or absence of a completely symptom-free phase as soon as the period starts.  It is also important to note if the symptoms are mild, moderate, or severe.  After completing a symptomatology chart for three months, you should discuss the results with your physician.  He/she will advise you if you have PMS and if so, will prescribe the most effective treatment for you.  No two women will respond the same way to the various treatments and no one treatment is effective for all women.

HOW IS PMS TREATED?
Change in dietary habits:
One of the most widely recommended methods of treatment is change in dietary habits. Pay attention to the foods you eat and begin to eliminate those foods that aggravate PMS. Caffeine, chocolate, alcohol, refined and processed foods, dairy products, foods with high sugar and salt content, additives and artificial colorings often make PMS worse.  Foods that reduce PMS include whole grain bread and cereals, fruits and vegetables, legumes, rice, carrots, broccoli, sesame and safflower oils.

Nutritional Supplements:
Increase foods that are rich in calcium, magnesium, Vitamin B6 and Vitamin E. Supplementing the diet with Vitamin B-6 (100mg. twice daily) and magnesium (300mg daily) is recommended to relieve PMS symptoms.  Calcium (1200 mg daily) has been shown to reduce physical and mood symptoms associated with PMS. Premenstrual breast swelling and tenderness associated with fibrocystic breast chances may be relieved by eliminating caffeine and taking Vitamin E (400 IU daily).

Exercise:
Thirty minutes of cardiovascular exercise daily and lifting weight 30 minutes twice weekly helps PMS.

Relaxation and Counseling:
Stress reduction and relaxation help control PMS symptoms.  Schedule fewer activites during the week prior to your menses.  Yoga, massage and Pilates may also help.  Make sure you get enough sleep. Meeting regularly with a professional counselor helps to obtain advice and guidance in changing long established lifestyle patterns. Being aware of your symptoms may help prevent conflicts with others.

Hormonal Therapy:
Oral contraceptive pills and progesterone may help with the physical symptoms associated with PMS.

Anti-depressants:
Extensive research has shown that the serotonin reuptake inhibitors (SSRIs) such as Prozac or Sarafem reduce symptoms of PMS. They can be used two weeks before the onset of symptoms or throughout the month.

NSAID medications:
Ibuprofen (Motrin, Advil) and Naprosyn (Aleve) can help reduce pain.  

WHAT OUTCOME CAN BE EXPECTED FROM THESE TREATMENTS?
Successful treatment depends on you.  PMS can be controlled or eliminated, depending on the severity of the symptoms, but you must take an active and educated role in your treatment.

DIETARY GUIDELINES FOR PMS
Because of the wide variety of symptoms that are experienced by women with PMS, there have been numerous recommendations for altering ones’ diet to control these symptoms.  In general, we have found the following dietary guidelines to have been helpful to many women with PMS and are consistent with a safe, nutritious, and well-balanced diet.  If you are on a special diet for a health condition (such as diabetes), you should consult with your physician or dietitian before making any changes.

The following guidelines should be followed 7-10 days prior to menstruation.

1. Eat 6 meals per day.  Small meals with a protein are usually recommended.  Proteins include milk, meat, fish, poultry, low sodium cheese and peanut butter.
2. Restrict caffeine.  Avoid regular coffee, tea, chocolate, and soft drinks containing caffeine.
3. Restrict sodium/salt intake.  Avoid salt, seasoning salts such as garlic salt, onion salt, celery salt, salt, MSG.  Seasoning sauces: soy sauce, Worcestershire sauce, steak sauce, barbeque sauce.  Condiments: pickles, relishes, catsup, prepared mustard, prepared horseradish, sauerkraut.  Canned/processed meats, fish, poultry, cheese, corned beef, pastrami, bacon, sausage, hot dogs, cold cuts, regular cheese.  Canned soups, including bouillon.
4. Restrict sugar intake.  Avoid sugar, honey, jam, jelly marmalade, syrup, preserves, cake, candy, cookies, donuts, pastries, pies, popsicles, puddings, regular soft drinks, beer, wine, alcoholic beverages.
5. Eat food high in magnesium, Vitamin B6 and Vitamin E.  Extra vitamins and mineral supplements are not required if you eat a balanced diet with emphasis on foods high in the above mentioned nutrients.  If you do not consume a balanced, diet, then a multi-vitamin-mineral supplement is recommended.

PMS READING SOURCES:

PREMENSTRUAL BLUE by Guy Abraham, M.D.

SELF HELP FOR PREMENSTRUAL SYNDROME Third Edition, by Marla Rph Ahlgrimm

PREMENSTRUAL SYNDROME SELF HELP BOOK by Susan Lark M.D.

 SYMPTOMATOLOGY CHART FOR PMS

The diagnosis of PMS depends on time of symptoms with the menstrual cycle and not with the symptoms themselves.  To determine if the symptoms are truly premenstrual, a woman should regularly record symptoms using a menstrual symptomatology diary.

INSTRUCTIONS FOR COMPLETING THE SYMPTOMATOLOGY CHARTS

1. Complete the entire questionnaire each month. Do not leave any of the questions unanswered.

2. Follow the instructions on the questionnaire to grade the severity of your menstrual flow.

3. Circle the number of your cycle for the chart you are completing (For example, the first chart you complete would be cycle 1, the second month and the second chart would be cycle 2, etc).

4. Use a separate chart for each cycle.  Additional copies may be obtained from your physician or photocopied from this page.

5. To insure that an appointment will be available at the end of your three cycles, call well in advance to schedule your visit.

6. Take your temperature with a Basal Body Temperature Thermometer (which can be purchased at most pharmacies).  A standard thermometer will not give the same results.  Take your temperature every morning upon awakening and before getting out of bed.  Leave the thermometer in your mouth, under your tongue, for a full three minutes.  Chart the results in the section labeled Basal Body Temperature. It is important to shake the thermometer down the night before as even this small amount of activity in the morning can elevate your temperature.

7. Weigh yourself at the same time every day.  This should be done upon arising, after voiding and before dressing or eating.  Chart your weight in the section labeled Basal Body Weight.

If you have questions regarding the completion of the form, or about PMS, please feel free to discuss this with your physician.

PMS Information pdf from Los Olivos Women's Medical Group