PMS Explained

with Francine Cosner, M.D., Obstetrician/Gynecologist, Advanced Healthcare

Posted: Oct. 1, 2005

The causes of premenstrual syndrome (PMS), a condition that is manifested by emotional and physical changes in women prior to menstruation, have yet to be clearly defined, “but some women may be more sensitive than others to changing hormone levels during their menstrual cycle,” said Francine Cosner, M.D., an obstetrician/gynecologist with Advanced Healthcare. And some medical researchers suspect that physiological, genetic, nutritional and behavioral factors combine in varying degrees and are possible causes.

“The symptoms of PMS are not made up, they are definitely real and repetitive,” she said. “They occur in about 75 percent of menstruating women and can interfere with their normal activities.”

Francine Cosner, M.D., Obstetrician/Gynecologist, Advanced Healthcare "The symptoms of PMS are not made up, they are definitely real and repetitive."

According to Dr. Cosner, the symptoms of PMS are physical changes that can be hormonally explained. “About 30 percent of these women have mild to moderate symptoms, which include breast swelling and tenderness, fatigue and trouble sleeping, upset stomach, bloating, constipation or diarrhea, headache, appetite changes and food cravings,” she said.

“Symptoms also include joint or muscle pain, tension, irritability, mood swings or crying spells, anxiety or depression, and trouble concentrating or remembering.”

What is PMDD?
Premenstrual dysphoric disorder (PMDD) is a severe, disabling form of PMS that involves mood disorders, such as depression, anxiety, tension and persistent anger or irritability.

Any woman who has a monthly period can have PMDD. It can get worse with age, but it goes away after a woman stops having periods.

“PMDD can get in the way of day-to-day living. If you’ve got it, you may not want to be around people, even those you love. You might find it difficult to take care of your kids, or go to work, or focus on other tasks. Your friends and family are probably aware of your moods and avoid your presence when you are going though these mood swings,” Dr. Cosner said.

Usually women with PMDD also have the other physical symptoms of PMS. “The symptoms occur during the two weeks before their period and might last up to a few days after their periods start,” she said.

Dr. Cosner said treatments with antidepressants called selective serotonin reuptake inhibitors (SSRI) can help many women with PMDD. The Federal Drug Administration (FDA) has approved two such medications to date — sertraline (Zoloft) and fluoxetine (Sarafem).

Easing PMS symptoms
There is no diagnostic test for PMS, but tests may be used to rule out other conditions in women who experience severe symptoms.

The most important indication of PMS is the cyclic nature of the symptoms. There is usually a symptom-free time period one week after menstruation ends.

“PMS symptoms vary from one woman to another,” Dr. Cosner said. “It’s a good idea to try to keep track of your symptoms for several menstrual cycles. Keeping a daily symptom calendar will help note which symptoms appear on which days of the cycle, and how bad the symptoms are.” Intuitive recognition of the symptoms also helps to deal with the syndrome, she added.

Many treatments have been tried for easing the symptoms of PMS, but no treatment has been found that works for everyone. A combination of lifestyle changes and other treatment may be needed, she said.

To help alleviate the milder symptoms, Dr. Cosner suggests trying dietary changes that include decreased intake of caffeine, sugar or salt.
“Exercise, too, can help manage the milder symptoms, as well as getting enough sleep, choosing healthy foods, and not smoking. Be sure you are getting enough vitamins and minerals,” she said. “Take a multivitamin every day that includes 400 micrograms of folic acid. A calcium supplement with vitamin D can help keep bones strong and may help with PMS symptoms. In more severe cases, diuretics, ibuprofen, or antidepressants may be helpful.”

Although PMS does not seem to be related to abnormal hormone levels, some women respond to hormone treatment. For example, one important approach has been using medications such as birth control pills to stop ovulation from occurring.

Francine Cosner, M.D.
Advanced Healthcare

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