Let’s face it; many of us might not feel at the top of our physical or emotional game just before that time of the month. With that said, most women of reproductive age experience mild symptoms of bloating, breast soreness, and irritability, which are tolerable.
Premenstrual syndrome (PMS) includes physical and emotional symptoms that occur repetitively each month during the second half of the menstrual cycle and which interfere with day-to-day life. Symptoms typically resolve with the onset of menstrual flow or shortly thereafter.
In contrast, premenstrual dysphoric disorder (PMDD) is a more severe form of PMS in which symptoms of anger, irritability, and internal tension are significant enough to interfere with personal relationships and day-to-day living. Women experience rapid mood swings, anger, hopelessness, tension and anxiety, difficulty concentrating, decreased energy, and feeling out of control. PMS occurs in 3–8 percent of women while PMDD affects 2 percent of women.
While the exact cause of PMS/PMDD remains unclear, it is generally thought to be due to altered levels of brain neurotransmitters, including serotonin and ovarian hormones, estrogen and progesterone. Risk factors for PMS and PMDD might include lower levels of education, smoking, and history of traumatic events, although the jury is still out on this.
The difference between PMS and PMDD
It’s important to make the distinction between PMS/PMDD and generalized depression and anxiety. The former diagnoses must include both a symptom-free time during the initial half of the cycle (the follicular phase prior to ovulation), and full resolution of symptoms shortly after menstruation begins.
Those with mild PMS symptoms might benefit from regular exercise. While this association is not well studied in rigorous scientific trials, evidence suggests a positive correlation. Anecdotally, I see this benefit in my practice day after day and suspect the release of endorphins (feel good chemicals in the brain) is responsible.
Dietary manipulation during the premenstrual week makes common sense. Avoid excess sugar, caffeine, and salt.
Dietary supplements for PMS, including vitamin B6 and calcium, have not shown benefit above placebo and are typically not recommended. Several OTC herbal remedies such as Serenal tm are effective for some. Stress reduction through yoga, meditation, or mindfulness exercising is surely recommended.
For women with more moderate to severe symptoms, and who have ruled out other medical issues such as thyroid imbalance or generalized depression and anxiety, more aggressive intervention is recommended. The birth control pill is commonly used to treat PMS and PMDD, particularly in those who also need contraception. The pill prevents ovulation and the hormonal fluctuations that follow. Alternatively, an antidepressant in the serotonin reuptake inhibitor (SSRI) class is first line therapy. These medications are given in a low dose and in a cyclical fashion, during the luteal phase of the menstrual cycle (after ovulation) and work by increasing levels of serotonin, a neurotransmitter in the brain.
Education is a vital component in dealing with PMS and PMDD; recognition that these syndromes are true medical diagnoses helps to validate those who suffer and provide reassurance and hope for successful treatment.