QUESTION: I know that something is wrong, for my life before my period is due is truly hell.
Yet when I try to get help from my physician, I am left frustrated and as unhappy as before my visit.
Why is this? Doesn't anyone know anything about premenstrual tension?
ANSWER: Although much has been written and many studies conducted to investigate premenstrual syndrome, the origins and best ways to treat still defy attempts to classify this disturbing ailment.
It may be that there is no single syndrome, and that the physical, emotional and behavioral changes that occur just prior to the menses may be due to a variety of different factors that affect each woman in a unique fashion, and with differences in intensity and timing.
Since the symptoms vary, it is clear that it is important to document these premenstrual changes (PMC) and to be certain that other conditions that could cause these problems are not the real reason for the symptoms.
The symptoms of premenstrual syndrome (that's PMS) are many and varied, but can be placed into nine categories.
I'll list them for you, and provide a few samples.
AFFECTIVE symptoms include anxiety and irritability, while BEHAVIORAL problems include decreased motivation and efficiency.
The AUTONOMIC nervous systems may provoke diarrhea, nausea and palpitations, while symptoms from the CENTRAL nervous system include clumsiness, dizziness and tremors.
DERMATOLOGICAL symptoms include acne and dry hair, while disturbances in FLUID/ELECTROLYTE balance cause bloating, edema and weight gain.
COGNITIVE symptoms include indecision, paranoia and even suicidal thoughts, while the NEUROVEGETATIVE system sees changes in libido, food cravings and lethargy.
PAIN symptoms can cause breast tenderness, headache, and joint and muscle pain.
Most clinicians agree that to make a diagnosis of PMC, symptoms should begin during the luteal phase of the menstrual cycle, which occurs after ovulation, and usually lasts for about 14 days during the last half of the cycle, the symptoms should disappear shortly after the start of menstrual flow, and there should be a symptom free period during each cycle that lasts for at least one week.
Treatment should be attempted when the symptoms occur during almost every period and when there is some impairment in normal function.
The symptoms that accompany menstruation are experienced by almost all women (97% in one study), but are severe in only 2% to 10% of women of reproductive age.
Getting a handle on a condition as perplexing as this one requires a thorough history and physical exam as a starting point.
You may want to keep a symptom diary to aid the physician in understanding the frequency and severity of each symptom, when they occur, and what may have set them off.
Daily morning weights are useful in calculating water retention problems.
A complete record of this type should be kept during a minimum of two cycles.
Treatment will have to be highly individualized to be effective and may use both nondrug strategies as well as medications.
Relieving stress by changing life styles, particularly during the second half of the cycle, may be an important first step, while eating nutritionally balanced meals may help.
These actions may play an important role in overcoming some of the symptoms, so that consideration of possible medications for the remaining complaints may become a bit simpler.
Properly used hormones, diuretics, antidepressants and antianxiety agents may offer the relief you are seeking. It is a long and difficult road, without the knowledge we need, but the outcome may make it worthwhile.
The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician.
Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.
