Women's Health: Surviving PMS

One of the few organizations missing from the roster of twelve step programs to help us with our lives, is a support group for the sufferers of PMS, or Pre-Menstrual Syndrome - one of the most widely known and perhaps the least understood of medical conditions.

Part of me, the militant feminist side that I don't let out very often, wonders if men were afflicted with this syndrome, other than as sometimes less than innocent bystanders, if there would be more research dedicated to this, or if it might be taken a tad more seriously.

In the meantime, however, let us visit the first chapter of this newly-formed group. Take your seats , please. The meeting is just about to start...

"Hi - my name is ****** and I have PMS."

OK - I'd like to thank you all for being here this evening. Before we get started, I have a few questions...

Who in this room has never heard of PMS (Pre-Menstrual Syndrome), never experienced Pms, never been affected by PMS in anyway, and just stumbled in here looking for the washroom (right...).

If you feel you are here by mistake, you're probably exactly where you need to be. It's OK. We all have been just where you are right now. Please feel free to share, if you care to, but remember it's also OK to just listen.

Though jokes, myths and misinformation abound - especially jokes - this can be a truly miserable time for many women.

Often referred to as "the gift", "Mother Nature's Little Trick", and "that time of the month", a woman's monthly visitor, her period, can be a time for rejoicing, or a time of almost unbearable discomfort.

This monthly event which welcomes us from girlhood into our child-bearing years is greeted with mixed feelings. For some, the event is joyful, a celebration of maturation and coming blessings. For others, this transition is viewed with some trepidation.

Chances are, if your mother or sisters have, or had, difficult or painful periods, you will too...but not necessarily. My mother suffered with her monthlies for years, and so did my older sister. I survived relatively unscathed until well into my thirties, and my younger sister has had relatively few problems.

PMS, or Premenstrual Syndrome, is a whole different creature.

Premenstrual Syndrome (PMS), also referred to as PMT or Premenstrual Tension, is a collection of physical, psychological, and emotional symptoms related to the menstrual cycle. While most women of child-bearing age have some symptoms of PMS, medical definition limits the scope to symptoms of sufficient severity to interfere with some aspects of life. These symptoms are usually predictable and occur regularly during the two weeks prior to menstruation. Generally, symptoms may vanish before or after the start of menstrual flow.

Some experts claim that all menstruating women experience some symptoms of PMS, however, more recent findings seem to show that only a very small percentage of women have significant symptoms other than the normal discomfort associated with menstruation.

Symptoms can include:

• Abdominal bloating and cramps
• Breast tenderness or swelling
• Stress and/or anxiety
• Insomnia
• Joint or muscle pain
• Headache
• Fatigue
• Acne
• Mood swings
• Irritability
• Changes in libido
• Chronic Diarrhea
• Hot Flashes
• Worsening of existing skin disorders
• Worsening of respiratory problems such as allergies or infections
• Worsening of eye problems such as conjunctivitis

Some of the risk factors are:

• High caffeine intake
• Stress may precipitate condition
• Increasing age
• History of depression
• Tobacco use
• Family history
• Allergies to nuts, trees, and grasses
• Dietary factors - there is evidence to show that low levels of certain vitamins and minerals, particularly magnesium, manganese, and vitamin E may be contributors

Some medical practitioners feel that this is a curiously North American phenomenon, and is largely brought on by culture and conditioning - North American women are raised to expect these symptoms, so they do, in fact, experience them. Most women find this view condescending and counter-productive, as they are capable of knowing their own bodies, and knowing the difference between normal menstruation and the symptoms they may experience otherwise.

The exact causes of PMS are not fully understood. It tends to be more common among twins, suggesting some genetic component, but current thought suspects that central-nervous-system neurotransmitter interactions with sex hormones are affected. It is believed to be linked to serotonin levels in the brain.

It has also been postulated that the roots of PMS may be evolutionary, to bring about the rejection of a non-fertile suitor. The non-fertile suitor would not cause impregnation, which would in turn bring on PMS. The infertile male/fertile female bond would be quickly broken down, freeing the fertile female to form a new pair bond. The greater the intense hostility of the premenstrual female, the sooner fertile mating would ensue. Proponents of this theory claim proof of its persistence over a substantial evolutionary time frame, and point to its existence in baboons (another primate species).

Another view holds that PMS is wrongly diagnosed in many cases. A variety of problems - chronic depression, infections, and outbursts of frustration - are often misdiagnosed as PMS if they happen to coincide with the premenstrual period. According to this theory, PMS is used as an explanation for outbursts of rage or sadness, even when it is not the primary cause.

Mood swings are both more consistent and more disabling than physical, or somatic symptoms such as cramps and bloating. Women who experience mood, or so-called psychosomatic symptoms are likely to experience these symptoms consistently and predictably, whereas physical symptoms may come and go. Most find the physical symptoms related to PMS are less disruptive and easier to treat effectively than any emotional symptoms.

While researching PMS, I came across this lovely little piece of "doctor speak":

PMS does not generally worsen over time. Women tend to experience the same symptoms at the same intensity near the end of each cycle.

Treatment for specific symptoms is usually effective at controlling the symptoms. Even without treatment, symptoms tend to decrease in perimenopausal women, and disappear with menopause.

…which is much like saying that menstruation disappears with full menopause. How silly! Of course the symptoms of PMS, associated with menstruation, cease when the cause (the fluctuation of hormones during menstruation) is removed...

"Yes, Doctor, she was suffering deep depression, but as soon as she felt better, she wasn't depressed any more"

Whatever the cause of the "hormone storm" that plagues so many women each month, there are a number of things we can do to make things more bearable for us, aa well as for those who love us. These range from pharmaceutical intervention to herbal remedies and life-style changes.

It was common some years ago for your doctor to pat your hand and say soothing things about worry and your nerves. Most of them tended to act like we were all imagining the whole thing regardless of the clinical symptoms we presented. I remember having a great row with one friend who was considering a hysterectomy.

Her (male) obstetrician had informed her the only real cure was a hysterectomy. He then went on to explain, the Greek roots of the word, from which our modern term "hysteria" is derived. She then relayed to me that he said he thought that removing her uterus could relieve her symptoms, as it would remove the hormonal imbalance that was creating her hysterical response each month...of course, if she still wanted to have children, she would just have to tough it out and wait for menopause, when all her symptoms would magically disappear.

Modern thought offers a bit more in the way of practical treatments. Many treatments are prescribed for PMS, including diet or lifestyle changes, and other supportive means. Medical intervention usually takes the form of hormonal intervention and use of SSRIs, or Selective Serotonin Re-uptake Inhibitors.

Dietary and life-style changes:

• Eating small meals more often, combined with taking a fish oil supplements keeps the blood sugar stable and lessens mood swings
• Avoid too much salt, sugar, caffeine and alcohol
• Get adequate sleep
• Dietary supplements can be beneficial: Calcium, Vitamin E, Magnesium
  
• Taking moderate exercise such as walking can be greatly beneficial
• Supportive therapies that include evaluation, reassurance, and informational counseling

If you and your doctor may agree that medical intervention is warranted, it may include the use of a number of promising drug therapies:

• Non-steroidal anti-inflammatory drugs such as Ibuprofen
• Diuretics to help reduce water retention
• A combination of hormonal contraception pills and a contraceptive patch
• SSRIs can be used to treat severe PMS – often one of sertraline, paroxetine, clomipramine, fluvoxamine, and nefadozone
• Gondatropin-releasing hormone agonists can be useful in severe forms of PMS, but his therapeutic regimen should be undertaken with caution because of potentially severe side-effects

I truly believe though, as with any condition, the attitude with which we approach our symptoms and treatment can either make us or break us. Will you be a monthly victim, or will you courageously stand up and take charge of your body, whether it wants to co-operate or just stay in bed for a few days out of each cycle. We can learn a lot form our European, Asian, African and Australian sisters who tend to view this as a natural occurrence and, unlike some of our more Puritanical ancestors, an event to be received as a blessing, not "the curse" we sometimes take it to be.

...and a little humor never hurts...