Premenstrual Syndrome (PMS)

Yes, believe it. Scientists now say women can conquer their monthly blahs. Everything you need to know about the latest treatments.

I always know when my period is due: My breasts become sore, my belly feels bloated, and my sweet husband suddenly transforms himself into an irritating jerk. There are times I could laugh at how my menstrual cycle runs my life--except I'm usually too weepy.

Yet despite my monthly lows, I still consider myself fortunate. Unlike in my mother's generation, doctors today are unlikely to inform me that it's all in my head. Premenstrual syndrome--PMS--is now recognized as a legitimate medical condition that in mild to moderate form affects up to 85 percent of all women. (Another 5 percent have symptoms so severe that they interfere with their work, family, or social life.) What's more, recent advances in treatment-ranging from calcium supplements to antidepressants--suggest for the first time that PMS suffering may soon be a thing of the past. That said, finding the monthly antidote that's right for you requires experimentation. Here's help to get you started.

It's a hormonal thing

The symptoms of an impending period are reasonably obvious-some physical (bloating, acne, food cravings, muscle aches, weight gain, headache, breast tenderness, heart palpitations, and disturbed sleep), others psychological (irritability, anxiety, mood swings, and poor concentration). Many women have a combination of complaints.

You've undoubtedly heard that hormones are at the heart of this constellation of complaints. While this is a widely accepted medical truth, scientists still can't identify any particular culprit, such as abnormal levels of estrogen or progesterone. One theory is that serotonin--the happiness-inducing brain chemical--fluctuates at this time of the month, causing rapid changes in your mood and energy level. Indirect evidence suggests this chemical does factor into PMS: In several studies, PMS sufferers who took Prozac or other serotonin-affecting antidepressants experienced a 50 percent or better improvement in symptoms.

Genetics may also play a role. And having a baby--as well as starting or stopping birth control pills--could trigger the onset of severe PMS. Most perplexing to researchers is that many women experience an increase in PMS symptoms as they age. One possible explanation for this is changes in estrogen production, causing greater swings in serotonin as a woman enters her 30s. Another explanation suggests it's not that a woman's symptoms intensify, but that her tolerance lessens: "In your 30s, you have children, a husband, a job. Symptoms may feel more disruptive to your already jam-packed life," notes Jean Endicott, Ph.D., director of the Premenstrual Evaluation Unit at the Columbia-Presbyterian Medical Center, in New York City.

Do you have it?

At first, diagnosing PMS seems like a no-brainer: one or more physical or psychological symptoms that regularly kick in within two weeks of the start of your period. But because a number of medical problems--including thyroid deficiency; anemia, depression, irritable bowel syndrome, allergies, and migraines--may also intensify in the days before your period, it is often difficult to distinguish between other health issues and PMS.

If you suspect your preperiod blahs are attributable to PMS, your first step is to seek out a physician's advice. An accurate diagnosis has two steps: To begin, your doctor needs to do a thorough medical and psychological history, and you should get a blood test to detect possible underlying health conditions like an underactive thyroid. Second, you will probably be asked to keep a detailed symptoms diary for a minimum of two months. How it works: Your doctor supplies a list of dozens of symptoms related to PMS, from irritability to fatigue. Every day, even on the days when you are not nearing your monthly, you record and rank any health complaints in your diary on a scale of "none at all" to "extreme." After two months, review your log With your doctor. You will be able to see whether there is a clear-cut PMS pattern--one in which symptoms increase during the 14 days before your period, then diminish within one hour to a few days after you start bleeding.

"The diary is key to a correct diagnosis," says Bruce Kessel, M.D., an associate professor of obstetrics, gynecology, and women's health at the University of Hawaii, Honolulu.

Finding PMS relief

If your diagnosis is confirmed, don't assume that means you have to head straight for medication. In fact, self-help measures alone can sometimes work wonders for PMS, stresses Endicott. "Even women with severe symptoms may find they improve sufficiently simply by making lifestyle changes and trying non-drug treatments."

One major medicine-free breakthrough: calcium. In a recent study of 466 women suffering from PMS, those women who received 1,200 milligrams of calcium per day for three full menstrual cycles saw their symptoms--low mood, water retention, food cravings, and lower-back pain--cut almost in half. "Calcium as a PMS remedy is a no-risk, win-win proposition," affirms Adrianne Bendich, Ph.D., an adjunct professor at the Institute of Nutrition, Columbia University School of Physicians and Surgeons, in New York City. "It's safe, it benefits your bones, and the supplements are inexpensive compared with prescription medications." Don't forget, increasing the amount of dairy in your diet--yogurt, low-fat milk and cheese--will increase your calcium intake, as well (although the study focused exclusively on the use of supplements).

Exercise has proven to be another successful self-help strategy for fighting PMS. Hormonal changes can cause women to gain preperiod pounds, leading to a bloating sensation. The weight gain, which is primarily due to water retention, makes many women feel uncomfortable and unattractive during this time of month. But exercise has been shown to elevate levels of naturally occurring chemicals in the body that improve mood. As little as 20 minutes of activity a day can help women feel better about PMS-related weight gain.

So slip on your running shoes and stock up on calcium-rich Tums. But if these self-help measures fail to relieve your symptoms, talk to your doctor about other solutions:

• THE PILL

For some women, low doses of oral contraceptives work miracles. If symptoms are primarily mood related, however, the Pill can be hit-or-miss, sometimes even exacerbating the problem. "Women often have to experiment to find the brand, dosage, or type that helps their PMS symptoms," says Endicott.

• SPIRONOLACTONE

The antibloat agent. Although experts differ on its effectiveness, several trials have demonstrated that this prescription diuretic reduces abdominal bloating; some studies show an improvement in other PMS symptoms as well. The usual dosage is 100 mg daily, taken for the 14 days before your period. (Note: Spironolactone is the only diuretic shown to help alleviate PMS.)

• SARAFEM ("Prozac for PMS")

Zoloft, and other serotonin-regulating antidepressants (SSRIs). In trials, "most women not only reported better mood, but physical symptoms--like bloating and breast tenderness--were helped too," says Ellen Freeman, Ph.D., codirector of the Premenstrual Syndrome Treatment Program at the University of Pennsylvania Medical Center, in Philadelphia. For PMS, antidepressants may be taken during the 10 to 14 days prior to a period--not continuously, as with depression. And SSRIs boost mood immediately in PMS sufferers; for people taking an SSRI for depression, results usually take two to four weeks. (SSRIs do have side effects, including diminished interest in sex.) Because the safety of long-term, intermittent SSRI use is unknown, women, in consultation with their doctors, should test their ability to do without the drugs at some point.

Remember, finding a PMS treatment that works may involve trial and error. "Don't be afraid to switch gears and try a new tactic if something fails to work after three cycles," advises Gladys Frye, M.D., former associate director of Lancaster General Hospital Family Practice, in Pennsylvania. The bottom line? Now that new PMS solutions seem to arrive almost monthly, there's no reason anyone should suffer. Virtually every woman has options that can vastly improve the quality of her life.

What's ten times worse than PMS?

Premenstrual dysphoric disorder (PMDD), a condition in which your preperiod symptoms are so bad that your. ability to function suffers--you miss work or avoid social commitments, for instance.

"Women with PMDD get so depressed, they refuse to leave the house; some become so angry and irrational, they fear they can't care for their children properly," says Ellen Freeman, Ph.D., codirector of the Premenstrual Syndrome Treatment Program at the University of Pennsylvania Medical Center, in 'Philadelphia. In extreme cases, doctors may suggest a GnRH agonist--a drug that induces a medical menopause and is a last-resort treatment for PMDD. It makes PMDD vanish, but also triggers the same symptoms as menopause: hot flashes, infertility, night sweats, and bone-density loss. Some doctors report greater success and fewer side effects when combining a GnRH agonist with hormone replacement therapy.

Treating PMS Most effective treatments are aimed at increasing levels of the deficient neurotransmitters. Some seek to replace the neurotransmitters directly, others to eliminate the estrogen and progesterone fluctuations responsible....

Last updated Jan 4/07