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 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).
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.