PMS. What It Is and How You Can Beat It.
By Lewis E. Sullivan, M.D., FACOG
Kim H. sat in my office nervously twisting a tissue in her fingers.
She seemed on the verge of tears. Kim is an attractive 32 year old
bank executive. Her husband, Frank, is a successful general
contractor. They have two children. The last child I had delivered
about two years ago. She had requested this consultation because in
her words, "Doctor, I think I'm losing my mind. It seems lately that
I get so angry at everything. I love Frank but I get so angry with
him. He says I always pick on him and nothing he says or does
seems to make any difference. I 'm even angry at the kids. A few
days ago, Jeff, my two year old spilled something which he always
does and I went ballistic. I ran out of the room shaking because I
just knew if I stayed I could really hurt him. I guess Frank's right I
need to see a psychiatrist." Further history taking revealed that Kim's
sex life was also suffering. "I used to love it when Frank would
come up behind me and fondle my breasts. I knew that he still
desired me and that made me feel wonderful. Now my breasts are
so sore I can't stand to wear a bra some days much less have them
touched and with this cramping and bloating forget about sex."
Kim's weight was also bothering her. She continued, "I can't seem
to get enough chocolate. I could eat two or more candy bars at a
sitting. I never used to be that way. I'm starting to gain weight,
sometimes a couple of pounds overnight." Her physical examination
was entirely normal. I made some suggestions and asked that she
come back in three months.
Kim returned appearing less anxious. She said that the daily diary of
how she felt revealed that she was worse about a week before her
period started. Once she started her menses she felt "normal" again.
"I guess that means I am really crazy, right?" I explained that she
was not crazy. What she described was a classic case of PMS or
premenstrual syndrome. She volunteered that she had started
walking with Frank almost every night. Kim changed her diet. She
ate more healthy foods and ate less food at more frequent intervals.
The supplements I had suggested seemed to be working and Frank
said she seemed like her old lovable self again. We agreed that she
would report on her progress by phone.
Several studies estimate that PMS effects six out of ten women.
Flares of acne, abdominal bloating and cramps, as well as changes in
libido, headaches (including migraine) and craving salty foods are
common. Symptoms range from mild to severe. Depression and
anger can border on full blown psychosis. It is important to
remember that PMS symptoms practically disappear when the
menses starts. Anger, rage or depression that is present all the time
is not part of this syndrome. In such cases the woman might wish
to seek a consultation with her healthcare provider.
The exact cause or causes of PMS are unknown. We do know that
PMS is a real physical disorder and not just part of being a woman.
Many researchers have shown that whatever the cause it rests
within the woman's ovaries. PMS symptoms abruptly stop when
ovaries are removed or inactivated by drugs or disease. Dr. Katarina
Dalton, in England in the early 1960s, pioneered the theory that PMS
resulted from a deficiency of progesterone, the second of two major
female hormones. She obtained success when she supplemented her
patients with extra progesterone. Dr. Dalton discovered, as have
many other since then, that the progesterone must be "natural"
progesterone not synthetic. Birth control pills and the drug Provera
contain synthetic progesterones called "progestins." Researchers,
including Dr. Dalton, found that synthetics often made PMS worse.
This accounts for some women stopping the "pill" to avoid their
PMS symptoms.
Both natural and synthetic progesterones come from a wild Mexican
yam. Natural progesterone is chemically identical to human
progesterone. Progestins only closely resemble the human form.
Natural progesterone, when swallowed, loses most of its potency
through liver metabolism. This requires a much larger and therefore
more costly amount of hormone to provide therapeutic blood levels.
Progestins do not share this problem.
Today you can buy natural progesterone in a cream form to rub into
your skin. The trade name is ProgestaCare and it is available for
vaginal insertion. Finally, the FDA recently approved for sale oral
capsules of natural micronized progesterone called Prometrium.
These come in 100 mg capsules to take twice a day. All of these are
rather expensive.
Modern research proved that depression comes from an imbalance
of brain neurotransmitter hormones called serotonins. Popular
antidepressants such as Prozac have proven to be miracle cures for
not only moderate to severe depression, but also the anger or rage of
PMS. Your healthcare provider can give you specific information on
dosage, side effects and contra indications.
Luckily, most women with PMS can receive effective treatment that
is more natural and much less expensive. First, you must keep a
daily diary or chart of how you feel over three months. To be PMS,
your symptoms must concentrate in the seven to ten days preceding
your period. Remember a cycle starts with the first day of flow and
goes until the first day of the next month's flow. The days from
your ovulation until you start menses are a constant of fourteen
days. So if you have twenty-eight day cycles, your symptoms will
start on or after the fourteenth day. On the other hand if you have,
say, a thirty-two day cycle your start day will be on or after day
eighteen.
For unknown reasons, women with PMS demonstrate either a
deficiency or perhaps a resistance to certain vitamins and minerals.
Calcium and magnesium are also often low in PMS women. The
average diet gives about 300 or 400 mg of calcium a day. You need
doses of 1200 to 1400 mg for the best results. Four Tums EX or six
regular Tums per day can supply this amount easily and cheaply.
You also need 400 units of vitamin D to properly absorb the
calcium. Too much calcium can result in kidney stones and
disorders so don't exceed recommended doses. Magnesium is
available in 50 mg tablets. Doses of 200 mg per day are considered
safe. Take with or after food because it can upset the stomach.
Vitamin B-6 in doses up to 600 mg per day are often useful. Start at
100 mg and increase by 100 mg every three or four days until
effective. Avoid doses above 800 mg as toxicity can occur. B-6 is a
mild diuretic and helps to relieve bloating and water retention. Divide
B-6 into several doses throughout the day with the largest at
bedtime. Breast tenderness frequently responds to vitamin E in 800
unit doses. If your symptoms are mild you may get these additional
vitamins and minerals from diet alone. Dietitians and nutritionists can
supply you with a list of food sources.
For cramping and muscle aches, try over the counter NSAID pain
relievers such as Aleve or Motrin-IB. If one brand is not effective
try another. People can react differently to these medications. Be
sure to follow the suggested dosages on the bottle.
Finally, large muscle exercise can relieve stress and help with
depression. Walking, jogging, swimming or bike riding can relieve
many symptoms. Avoid food cravings. Folklore has it that if we
crave something our body must need it. That is simply not true.
Much of the fatigue in PMS is the result of rapidly rising and falling
blood sugar levels. Eating four to six small meals a day rather than
three can help stabilize glucose levels. Avoid high sugar foods like
candy, sodas and chocolate. Concentrate on whole wheat foods,
pasta, low fat proteins like fish and tofu. The same avoidance goes
for alcohol and caffeine products. Alcohol acts like a sugar and
caffeine adding to the general stress and anxiety levels. Avoid salty
foods like cheese, soups, smoked meats and fish, nuts, soy sauce
and Oriental foods as they are all high in salt. Your body only stores
salt water. Plain water is easily excreted by the kidney. Drink lots of
plain water to aid in bloating and water retention.
So there you have it. By adjusting your diet, adding exercise and
taking a few supplemental vitamins and minerals most of you will do
very well. For others with more severe symptoms, there are
progesterone supplements or perhaps Prozac. The good news is that
you can do something about the spectrum of symptoms of PMS.
You can gain back your self-control. You can fight and win your
battle to lessen and even eliminate PMS from your life.