Knock Out PMS: Help is available for symptoms ranging from mild to intense

We can help you develop a plan to knock out your PMS symptoms
We can help you develop a plan to knock out your PMS symptoms

Amy L. Metzger, CNM

Premenstrual syndrome, more commonly called PMS, is common fodder for jokes, but for many women, it’s no laughing matter. It’s hard to pin down exactly how many women are affected, but it’s likely that 75 to 90 percent of women experience PMS in some form during their lifetimes, and symptoms range from mild to intense.

While the exact cause of PMS is unknown, it seems to be the result of cyclical hormonal changes and chemical changes in the brain. There is also no test to diagnose PMS––instead, women are often tested to rule out other causes, like pregnancy, endometriosis or cancer, when symptoms arise.

While we don’t really know what causes PMS, and why some women experience it and some don’t, it is a true medical condition. Unfortunately, many women are made to feel like they are being dramatic about how bad they feel. Everyone is different, and each person’s experience can change over time. The good news is there are things we can do to lessen its impact.

PMS Symptoms

PMS typically occurs just past mid-cycle, between ovulation and the onset of menstruation, and can last from a couple days to a week or more.

Symptoms of PMS are many and include emotional and behavioral problems such as tension, anxiety, mood swings and depression, appetite changes and cravings, insomnia and trouble concentrating.

Physical symptoms can include muscle and joint pain and cramping, breast tenderness, fluid retention and bloating, fatigue, headaches, acne, constipation, diarrhea and more. Most women with PMS experience several symptoms each month.

We ask women to keep a journal of their symptoms for a few months. When we see a pattern to the symptoms, and rule out other causes, PMS is the most likely diagnosis. For women with extreme symptoms, especially the emotional and behavioral ones, the diagnosis may be premenstrual dysphoric disorder (PMDD).

Lifestyle Improvements

We can also use the journal to help pinpoint triggers. For example, if you get headaches a few days before your period, we may recommend cutting back on caffeine the week before your period to see if that helps.

Lifestyle changes you can make that may relieve or at least lessen your PMS symptoms, include:

  • Eating smaller, more frequent meals and limiting salt intake
  • Regular exercise, like walking for 30 minutes a day
  • Getting enough sleep
  • Yoga and massage
  • Limiting caffeine and alcohol
  • Not smoking
  • Eating a healthy diet that’s rich in calcium

You may need to experiment to find out what works best for you. If your symptoms are severe enough to impact your daily life––you regularly miss school, work or other activities–– and nothing you’ve tried is working, it’s time to talk your women’s health provider.

Medical Treatment for PMS

Medical treatment varies based on each woman’s symptoms and their severity:

  • Antidepressants can help women with mood symptoms. Some can be taken daily, and others only in the two weeks prior to each period
  • Nonsteroidal anti-inflammatory (NSAIDS), such as ibuprofen or naproxen, can help relieve muscle, joint and breast pain
  • Diuretics can help with swelling and bloating
  • Hormonal contraceptives, like the pill, can relieve or lessen a range of symptoms

If you have symptoms that disrupt your life every month before your period, come and see us. We’ll work with you to develop a plan to treat your specific symptoms so you can have as little disruption to your life as possible.

Choosing the birth control method that’s right for you

Anne Vaillant, CNM, says there are a number of factors to consider when choosing a birth control method.
Anne Vaillant, CNM, says there are a number of factors to consider when choosing a birth control method.

Factors to consider when weighing your options

Anne Vaillant, CNM

A generation ago, birth control options were pretty limited: condoms, the pill, and the rhythm method (abstaining from sex when you are at your most fertile). Today, there are a wide variety of options, but it’s important to find the one that will work the best for you and your lifestyle.

Consider This

Effectiveness: When estimating the effectiveness of the various forms of birth control, it’s important to remember that they are calculated assuming you are using the method as instructed. For the pill, this means you must take it every day at about the same time to maximize its effectiveness. Start skipping days or taking it erratically, and its effectiveness decreases. Other options require diligence once a week or once a month. Some require regular trips to your health care provider. This requires a level of commitment.

On the other hand, options like a condom allow you to only think about birth control when you really need it—right before sex—but because condoms can tear or come off, you may be sacrificing effectiveness for convenience.

Price: Depending on your insurance, some birth control options are more affordable than others. Many options require prescriptions, while some are available over-the-counter.

Convenience: Some methods of birth control, like implants, are effective for up to three years, and even longer with IUDs. Once you have them, you don’t have think about birth control for significant periods of time. However, if you aren’t interested in a long-term option, you may be more willing to put up with the inconvenience of, for example, getting the shot every three months.

“Ick” Factor: Some women are more squeamish than others. If you will feel uncomfortable inserting something far up in your vagina, options like the ring may not be for you. Also, some require the addition of a spermicide before insertion, which some women find messy.

Allergies/Sensitivities: If you have any allergies or sensitivities, it’s important to know what each birth control option contains. Latex allergies may rule out some of the most common type of condoms (they are available in latex-free varieties). Some women have reactions to spermicide; others find the patch gives them a rash. If you are prone to urinary tract infections, the diaphragm may increase your risk for more.

Side Effects: Many forms of birth control (such as the pill, patch and ring) contain hormones—typically estrogen and progestin—that can result in a range of side effects, including some that are short-term and some that aren’t. Some women tolerate progesterone better than estrogen, so an option like the injection, which contains progestin only, may be a better choice.

Side effects aren’t all bad; certain forms of birth control, like the pill, can reduce the frequency, heaviness and cramps of your period.

At A Glance

The chart below provides a brief synopsis of the most common types of birth control, comparing them based on the factors described above.

Method Effectiveness Frequency Prescription Do-It-Yourself Estrogen
IUD/Hormonal 99%+ 5-7 years Yes No Yes
Implant 99%+ Every 3 years Yes No No
Vasectomy 99%+ Once/ permanent Surgery No No
IUD/Copper 99% 10-12 years Yes No No
Shot 94-98% Quarterly Yes No No
Pill 92-99% Daily Yes Yes Yes
Patch 92% Weekly Yes Yes Yes
Ring 92% Monthly Yes Yes Yes
Diaphragm (w/spermicide) 88% Every time you have sex (within 6 hours) Yes Yes No
Male Condom 82% Every time you have sex No Yes No
Cervical Cap (w/spermicide) 80% Every time you have sex (within 48 hours) Yes Yes No
Female Condom 79% Every time you have sex No Yes No
Sponge (w/spermicide) 76-88% Every time you have sex (within 24 hours) No Yes No
Rhythm Method (or withdrawal) 76-78% Every time you have sex No Yes No

 

Talk to Your Healthcare Provider

Your OB/GYN or certified nurse-midwife can help you choose the birth control method that’s right for you. Let them know what factors are most important to you, and be honest about any concerns you have.

For example, let your provider know if you want long-term or short-term—or even permanent—protection against pregnancy, as some options are easier to reverse than others. If you also want protection from STDs, condoms are the only option that offers this, but they can be used in conjunction with other birth control options to boost their effectiveness for pregnancy prevention.

Often, short-term side effects resolve in a few months, but if you are experiencing side effects that you find intolerable or concerning, talk to your health care provider about what you are experiencing and discuss other options.

If you need guidance about birth control, schedule an appointment online or call us: 413-562-8016 for our Westfield office or 413-736-9978 for our Springfield office. We’ll be happy to talk with you about your options and find birth control method that’s best for you.