PMS: Causes and Treatments
What exactly is PMS and how can I ease the symptoms?
What Is PMS?
As many as 85 percent as menstruating women suffer from mild to moderate premenstrual syndrome (PMS). Symptoms can include breast discomfort, cramps, headaches, low energy, fluid retention, mood swings, irritability, and crying jags. While the symptoms are wide-ranging, the timing of their appearance -- one to two weeks prior to menstruation -- is all too predictable. For most women, symptoms go away once their period starts.
No one knows exactly what causes premenstrual syndrome. Some studies suggest a correlation between PMS symptoms and a brain chemical called serotonin. Reduced levels of serotonin are associated with depressed moods, anxiety, food cravings, and problems sleeping, similar to some women's premenstrual symptoms.
Research also shows that hormones play a role--but just what that role is remains to be determined. In all women, progesterone rises and estrogen dips prior to the start of their period. Somehow, women with PMS are more sensitive to these fluctuations, says Nanette Santoro, MD, a professor at Albert Einstein College of Medicine in New York City.
It's not so much the hormones themselves but the way some women's bodies respond to them, reports Geoffrey Redmond, MD, a New York City endocrinologist. In PMS-prone women, the hormone changes late in the menstrual cycle act on the brain to increase vulnerability to any sort of distressing event or stress, says Dr. Redmond. So things that might hardly be noticed at a different time of the month can trigger irritability or tears.
The physical symptoms associated with PMS are also orchestrated by hormonal changes. Cramps are the result of estrogen and progesterone stimulating the uterus to make prostaglandins, which, when released, can cause contractions. Progesterone also stimulates swelling of the breast tissue, which can hurt. Headaches may be the result of the dip in estrogen, which causes blood vessels to contract and sets off an inflammatory response that causes pain. As to whether childbirth impacts PMS, Dr. Redmond notes that age is a bigger factor. Symptoms often first appear or worsen when women are in their 30s. Experts aren't sure why, but the way the body responds to hormones changes over time. Still, chasing a toddler when you don't feel well makes PMS more challenging to deal with than it was in your pre-kid life.
Easing the Symptoms
A range of low-tech strategies can help alleviate symptoms. However, since everyone's body is different, the key to overcoming PMS is finding what works for you, says Dr. Redmond. Here are some suggestions to try:
- Chart your rhythms. Keeping a record of your symptoms for two or three months will help you develop a plan of attack. Having a sense of what to expect will enable you to line up extra help when needed and avoid stressful activities when you're not feeling up to par. Your records may also reveal that your symptoms appear throughout the month but are worse prior to menstruation. In this case, you might have an underlying medical condition, such as depression or migraines.
- Stay active. Exercise increases endorphins, chemicals your brain releases that make you feel good. Even a quick walk around the block can make a difference. Many women who exercise regularly also report a reduction in physical symptoms of PMS. Exercise lifts your mood, and mood affects pain perception, says Dr. Redmond. When your spirits are up, the same physical symptom will be less distressing.
- Watch what you eat. Complex carbohydrates (brown rice, whole grains, pasta, nuts, fruits, and vegetables) have a soothing effect on mood and anxiety. These foods will give you more energy, unlike simple carbohydrates (foods with refined sugar), which cause blood sugar levels to fluctuate, causing your mood to plummet. Also limit salt intake for the week before your period; it causes water retention, bloating, and breast tenderness.
- Cut back on caffeine. Drinking coffee or caffeinated sodas while you're premenstrual can affect the nervous system, causing mood swings and irritability.
- Avoid alcohol. Alcohol restricts the flow of blood to the brain and can cause headaches and bloating. Try skipping it when your PMS symptoms typically appear. If you don't see a difference, you might try cutting back at other times of the month as well.
- Keep the calcium coming. Research has shown that 1,200 milligrams per day of calcium (in the form of citrate supplements which are most easily absorbed) may help improve your mood and reduce physical symptoms, such as cramps.
- Use pain relief. Anti-inflammatories, such as ibuprofen (Advil, Motrin, and Pamprin) and naproxen (Aleve) are best for overall body discomfort. If these don't work, you may need a prescription medication. Resting with a heating pad on your abdomen can also ease pain.
- Seek medical help. If none of these strategies work, discuss your symptoms with a doctor. You may be one of the 3 to 5 percent of women who experience a more severe form of PMS called premenstrual dysphoric disorder (PDD). Women with PDD often have mood-related symptoms severe enough to warrant drug treatment, usually with selective serotonin reuptake inhibitors (SSRIs), such as Prozac or Zoloft.
Reviewed 11/02 by Elizabeth Stein, CNM
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.