Is it PMS or it is Something Else?

PMS or premenstrual syndrome encompasses a variety of symptoms which occur between ovulation (mid cycle) to the onset of menstruation or shortly thereafter. Some studies show that 70-80% of women experience some degree of premenstrual difficulties. This occurs most commonly among women in their 30′s and with the increase of age and parity.

The behavioral and emotional symptoms of PMS include:

  • Angry outbursts
  • Anxiety
  • Irritability
  • Confusion
  • Crying spells
  • Depression
  • Heart palpitation
  • Poor concentration
  • Sleep disturbances
  • Social withdrawal
  • Thirst and appetite changes (food cravings)

The physical symptoms of PMS include:

  • Aches and pain
  • Bloating and weight gain
  • Headaches
  • Tender breasts
  • Swelling of the hands or feet

Causes of PMS

The cause of PMS is unclear. A deficiency of progesterone, lack of zinc and calcium, and an underlying endocrine dysfunction are commonly associated with PMS. A diet with a high intake of salt and refined carbohydrates and a low intake of food high in nutrition and vitamins cause the endocrine dysfunction and aggravate all symptoms.

An excess of prostaglandin hormones or an inadequate level of endorphins may also cause PMS. Endorphins, the natural painkillers produced by the brain, causes an alteration of the brain’s sensitivity to pain and other neural signals that affect moods and how the body excretes fluids, causing fluid retention.

Another school of thought indicates that women respond differently to the hormonal changes that occur with their menstrual cycles. Genetic factors also may influence the way some women metabolize hormones.

Treatment of PMS

The treatment of PMS varies for each patient. Not all patients present the same symptoms or the same degree of severity. Treatment may include the following:

Regular exercise The majority of women improve with regular exercise. During exercise, the body relieves endorphins, which help reduce anxiety and tension. Exercise also improves circulations, which in turn can decrease bloating and breast tenderness.

Dietary changes Avoiding dairy products; caffeine, medications containing caffeine, refined sugar (cakes, cookies and candies), fats, and alcohol, which increase the hormonal imbalance of PMS. A dietary regimen that reduces the salt intake will help improve both physical and emotional symptoms by decreasing water retention. Alcohol can increase the chance of migraine-like headaches and also act as a depressant.

A diet high in essential fatty acids such as flaxseed oil, rich in calcium or 1200 mg of calcium and magnesium supplements with a multivitamin, can ease PMS symptoms. One study showed that women taking 400 mg daily of magnesium during PMS experienced less breast pain, weight gain, nervous tension and headaches. Women who take 50 mg daily of vitamin B6 also can reduce their symptoms of PMS.

Natural progesterone therapy

Alternative therapies including Ayurvedic medicine, herbal medicine, chiropractic, acupuncture, and reflexology

Stress management techniques including meditation, yoga, etc.

Other modalities include using diuretics, analgesics, and in some case an antidepressant.

Studies have demonstrated that 1,200 mg of calcium per day can help reduce the severity of PMS symptoms after three months. Calcium help reduce moodiness, water retention, food cravings, and pain.

Women with PMS may be magnesium-deficient. Taking magnesium supplements may improve premenstrual mood changes, stabilize mood swings, reduces fluid retention and breast tenderness. Be sure to take a 10:4 or 2:1 ratio of calcium to magnesium. That is, if you take 1,000 mg of calcium, take 500 mg of magnesium.

Chaste tree or Vitex 225 mg daily of standardized extract has been shown to alleviates cramping and breast pain.

Vitamin E 400-1,600 IU daily has also been recommended although it is widely unclear exactly how vitamin E works to relieve PMS symptoms.

Essential fatty acids from flaxseed 1-2 Tbsp. of cold-pressed flaxseed oil or 4-6 Tbsp. of milled flaxseed daily. Flaxseed reduces PMS symptoms such as menstrual cramps, breast tenderness, and bloating. Although other foods and supplements provide essential fatty acids, flaxseed is by far the finest source.

About 10 percent of women have symptoms of PMS so severe that they are now categorized in a new disorder called Premenstrual Dysphoric Disorder or PMDD. The recommended treatment is an antidepressant.

Are these premenstrual symptoms related to PMS, PMDD, or is it something else? Many conditions or disorders that can mimic PMS or PMDD. They include:

  • Depressive and Anxiety Disorders – The symptoms of these disorders may worsen before or during a woman’s period making some women think that they have PMS or PMDD.
  • Stress-related Disorders – I know of many women who have been categorized into a variety ofsyndromes ordisorders while they were suffering from stress-related disorders that were the result of emotional and financial stress.
  • Chronic Fatigue Syndrome
  • Irritable Bowel Syndrome
  • Endocrine Problems
  • Migraines

Unfortunately, women are usually in family or job settings that do not fully support them. Could these symptoms be the sign of a woman’s body telling her about the needs to heal her wounds? Could her body be telling her to listen, to start doing what is good for her? Shouldn’t they stop conforming to the expectations of only attending to the need of others?

Such was the case of Cindy, a 42 year-old patient, who frequently experienced mood swings, feeling of hopelessness, difficulty sleeping, fatigue, difficulty concentrating, and lack of interest at work, especially before and during her menses. She was diagnosed with PMS. She faithfully tried all the recommended conservative modalities. But her symptoms were getting worse. She was then diagnosed with PMDD and prescribed an antidepressant approved for PMDD. Fortunately, she could not tolerate the side effects of the antidepressant and came to me for a second opinion.

After a long discussion, I found out that her symptoms started when her sick mother came to live with her. Cindy was the only one available for her care. Even though she was mentally and physically exhausted, she felt guilty asking anyone for help because her mother had cared for her as a child, and she felt she was obligated to reciprocate. When Cindy learned to accept help with her mother’s care, her symptoms improved greatly and she was able to gradually taper off then stop the antidepressant.

Are you one of these women?