Julianne M. Dunne, MD

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How to manage symptoms of premenstrual syndrome


Most women feel physical or mood changes during the days before menstruation.  When these changes affect a woman’s normal life, they are known as premenstrual syndrome (PMS).  Premenstrual syndrome can affect menstruating women of all ages and backgrounds.  The cause of PMS is unclear.  However, the symptoms can be managed in many women.


The Menstrual Cycle
 

To understand PMS, it helps to know how the menstrual cycle works. This will help you to predict and cope with the symptoms.  Menstruation is a normal, monthly process.  The average menstrual cycle lasts about 28 days.  Normal cycles can range from 21-35 days.  During the menstrual cycle, the ovaries produce hormones.  These hormones are called estrogen and progesterone.


Day 1 of the cycle is the first day of a period. On about day 5, estrogen causes the lining of the uterus to begin up to prepare for a pregnancy.  On about day 14, one of the ovaries releases an egg.  This is called ovulation.


After ovulation, progesterone levels increase.  If the egg is not fertilized by a sperm, the hormone levels decrease.  This signals the uterus, to shed its lining on about day 28 of the cycle.  This shedding, or menstruation, marks the start of a new cycle. 

Symptoms


Premenstrual symptoms are a common part of the monthly cycle.   In fact, at least 85% of women who menstruate have at least one premenstrual symptom. 

Women with PMS experience a pattern of symptoms month after month. They also find that the symptoms interfere with some aspect of their family, social, or work lives.  Common symptoms occur during the 2 weeks before a woman’s period and they resolve as the period ends.


Emotional and Behavioral Symptoms of PMS

Depression
Angry outbursts
Irritability
Crying spells
Anxiety
Confusion
Social withdrawal
Poor concentration
Insomnia
Increased nap taking
Changes in sexual desire


Physical Symptoms of PMS

Thirst and appetite changes (food cravings)
Breast tenderness
Bloating and weight gain
Headache
Swelling of the hands or feet
Aches and pains
Fatigue
Skin problems
Gastrointestinal symptoms
Abdominal pain


Diagnosis


To diagnose PMS a doctor must confirm a pattern of symptoms.  These symptoms must:
  • be present in the 5 days before her period for at least 3 menstrual cycles in a row
  • end within 4 days after her period starts
  • interfere with some of her normal activities

Treatment


If lifestyle or dietary changes do not reduce symptoms, your doctor may suggest medications.


Hormones
Often birth control pills can minimize the symptoms of PMS.  The pill will help decrease many of the physical symptoms associated with the menstrual cycle.  By taking pills in a continuous regimen, woman can minimize the number of periods they get each year thus minimizing PMS.

Antidepressants
Antidepressants, especially SSRIs such as Prozac or Zoloft, can be helpful in treating PMS.  These drugs can help lessen mood symptoms.  They can be used two weeks before the onset of the period or throughout the menstrual cycle.

Nonsteroidal Anti-inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin (ibuprofen) or Aleve (naprosyn), can help reduce pain.  These are most effective if taken when symptoms first begin as opposed to at their peak.


PMS, or something else?

Symptoms of other conditions may mimic PMS.  For instance, premenstrual dysphoric disorder (PMDD) is a severe type of PMS.  PMDD affects a small percentage of women with PMS. Your doctor will want to rule out this and other conditions before diagnosing PMS.


Depressive and Anxiety Disorders 
Castillo Dominici / FreeDigitalPhotos.net

These disorders are the most common conditions confused with PMS.  The symptoms of depression and anxiety are much like the emotional symptoms of PMS.  The symptoms of these disorders may simply worsen before or during a woman’s period.  This makes some think they have PMS.  The symptoms of depressive disorders often are present all month long.  With PMS, the symptoms go away after a period begins.  Some women may have depression and PMS.


Menopause

Women entering menopause may have PMS-like symptoms.  These symptoms include mood changes and fatigue.


You can help your doctor decide if the symptoms are caused by menopause or PMS.  A record of your symptoms and changes in your monthly cycle can be used to make a diagnosis.
Other Conditions
 

Your doctor will want to rule out other conditions that share symptoms with PMS.  These conditions include chronic fatigue syndrome, irritable bowel syndrome, and some endocrine problems.  PMS may also make the symptoms of other conditions increase.  These conditions include: seizure disorders, migraines and asthma.


Many women with PMS find relief with exercise and lifestyle changes.  Others may find dietary supplements or medicines to be helpful.  If you have PMS, talk with your doctor about ways to find relief.


Document
How to Manage Symptoms of Premenstrual Syndrome - Download this printable version

The Natural Times


WHAT YOU CAN DO

Lifestyle and dietary changes may relieve some PMS symptoms as well as some medicines.  You may have to combine options to find relief.


Aerobic Exercise
For many women, aerobic exercise lessens PMS symptoms.  It may reduce fatigue and depression.  Exercise can include brisk walking, running, cycling, or swimming.  Try to exercise at least 30 minutes most days of the week.  Aerobic exercise will also promote heart health and help control weight.

Relaxation
Finding ways to relax and reduce stress can help women who suffer from PMS.  Relaxing activities like yoga or massage may help.  Also be sure to get enough sleep.

Dietary Changes
Simple changes in your diet may help relieve the symptoms of PMS.  Your doctor may suggest a diet rich in fruit, vegetables, and whole grains.  Reduce your intake of fat, salt, and sugar.  Avoid caffeine and alcohol.

Dietary Supplements
Many vitamins and supplements can help lessen the symptoms of PMS for most women.

Calcium deficiency has been linked to PMS.  Studies have shown that taking 1,200 mg of calcium a day may help reduce physical and emotional symptoms of PMS.
 
We recommend *nutraMetrix Calcium Complete which also includes magnesium, known for reducing bloating, breast tenderness, and mood symptoms.






The B vitamins are also helpful in maintaining serotonin levels which stabilize mood and also provide added energy. 

We recommend
*nutraMetrix Advanced B Complex.






Herbal products that contain phytoestrogens are also helpful.  These are plants that contain estrogenic activity and lessen many of the hormonal fluctuations with PMS as an alternative or supplement to birth control pills or antidepressants.
 
We recommend *nutraMetrix Female Support Formula.







There are natural alternatives to NSAIDS. 

We recommend *nutraMetrix OPC3.  This is a mixture of superantioxidants and contains pycnogenol which has natural anti-inflammatory activity as an alternative to Motrin. 


nutraMetrix Isotonic Vitamins
available at our office or at
www.nutrametrix.com/dunnedelashomds



Julianne M. Dunne, MD
westmed medical group
3030 Westchester Avenue
Suite 202
Purchase, NY  10577
tel. (914) 848-8668
fax. (914) 948-1019