Premenstrual syndrome (PMS)

Q: I experience unexpected and rapid mood changes before menstruation, a few days before it starts. Can I somehow control them to avoid troubles at work and home? Such emotional drops really affect my life and relations with colleagues and family.

A: It is typical display of premenstrual syndrome (PMS). Some psychiatrists call it Premenstrual Dysphoric Disorder (PMDD), but it means pretty the same in your case.

Premenstrual syndrome is rather popular disorder experienced by more than 30% of woman worldwide. It reveals in various emotional and physical symptoms, and mood swings is one of the most typical symptoms. The problem is that PMS is not properly studied yet, the connection between PMS and emotional state is still unclear, so there is no definite treatment suitable for all. However a lot of patients find some therapies effective, such as taking magnesium mineral, calcium pills, St. John’s wort medicines or Prozac. These medicines have already shown its effectiveness and were clinically tested, that gives some guarantee for successful treatment. The rest of therapies mostly built on beliefs with no medical ground.

As for the vitamins and minerals, there are a few that can help:

-Vitamin E  for daily intake of 400-800 UI dose;

-Vitamin B6 – 50 mg daily or twice a day;

- for 1,000 – 1,500 mg daily;

-Zinc – 15-25 mg per day;

-Magnesium (325-750 mg daily according to doctor’s recommendations).

The herbs useful for treating PMS are flaxseed or borage oil, usually supplied in capsules. These oils give special fatty acids that can relief various pains and emotional PMS symptoms. Evening primrose oil is a popular treatment for increased breast tenderness. Chamomile or valerian root act as a sedative medicines that can remove aggressive mood or anxiety, but be careful and don’t take them at morning or daytime, as they reduce concentration. Dandelion leaves are effective for excess fluid excretion.

In Europe PMS is often treated by St. John’s wort (Hypericum) that already proved its effectiveness. The medical practice shows that the most helpful regime of its intake is 300 mg daily. From 10th cycle day till the periods start, increase the dose to 300 mg three times per day. Each cycle begins from the first day of menstruation. Sometimes it is enough to take less or increasing the dose only before ovulation (about 14th cycle day). It is individual in each case.

Remember that there are also non-medicine therapies that can help to reduce PMS symptoms. Exercises and diet are among such methods. Aerobics increases the output of endorphins and reliefs mood swings and depression, having positive effect on the whole organism. Replace simple carbohydrates (cookies or candies) by complex carbohydrates (vegetables), eat more frequently but by less dosing. You can use special “PMS Escape” drink with complex carbohydrates, but it more expensive than vegetables and grains. Try to limit alcohol intake, simple sugars or fattening foods also should be avoided.

If these measures don’t help, consult a doctor for finding another therapy including SSRI antidepressants. Some drugs like Zoloft or Prozac successfully treat PMS symptoms. They are ethical medications.

And don’t forget that PMS is not the only reason of mood swings. Some medical disorders like diabetes or endocrine system disorders, as well as psychiatric pathologies, may cause the same symptoms. If PMS therapy doesn’t help, it is better to see your doctor to find the actual reason and proper therapy.

About three fourth of women at childbearing age feel discomfort during premenstrual period caused by various symptoms of premenstrual syndrome. In 10 percent of cases premenstrual syndrome (PMS) reveals in much more serious form called premenstrual dysphoric disorder (PMDD).

The difference between PMS and PMDD is in the strength of symptoms. Being more severe, PMDD has bigger influence on women’s daily activities and psychological state. As a rule, the symptoms of PMDD reveal themselves in the last week of menstrual cycle and disappear in a few days after menstruation starts. The typical symptoms include:

1 – Depression, continual nervousness or sadness

2 – Shifts of mood with often wing-dings

3 – Heightened irritation and furiousness

4 – Apathy and loss of interest to usual day-to-day activities

5 – Pain in joints, muscular ache, headache and other flu-like symptoms

6 – Breasts hypersensitivity

7 – Tiredness and sleepiness

8 – Slumber disorders – insomnia or sleeping too much, problems with falling asleep

9 – Surfeit, constant feel of hunger or loss of appetite

The reasons of PMDD are not found yet. Most of scientists note big resemblance between PMDD and major depression. But PMDD also affects women without major depression history.

Premenstrual dysphoric disorder (PMDD) is healed by decreasing or preventing the impact of its sympthoms. The main drugs used for this are:

1 – Nonsteroidal anti-inflammatory drugs (NSAIDs) are able to relieve breast sensitivity and cramping. Advil, Mortin and other medicines of this group are usually taken before or at the beginning of menstrual period.

2 – Antidepressants including serotonin reuptake inhibitors (SSRIs) are able to ease emotional discomfort and problems with slumber.

3 – Oral contraceptives can be used to neutralize the main cause of PMDD. They stop ovulation that lead to hormonal stability.

4 – Nutritional supplements like calcium, magnesium and vitamin B-6 reduce various problems caused by PMDD. Taking them regularly helps to normalize physical and emotional state.

5 – Herbal remedies can be used to reduce emotional symptoms of PMDD and headaches, as well as improve sleep. L-tryptophan and chastberry are clinically studied remedies.

6 – Diet and regular physical exercises. They both effectively reduce premenstrual symptoms, as well as recondition the whole organism. Reducing caffeine intake may decrease anxiety and emotional instability. Carbohydrates are able to improve mood.

It is important to consult a doctor when feeling the aforementioned symptoms. Only a qualified medic can determine the origin of symptoms, if it is PMDD or other disorder. If the reason is PMDD, a doctor will prescribe specific treatment for your symptoms that will help to minimize the impact of PMDD.