The Perils of PMS

Understanding the severity of PMS
Of the estimated 40 million suffers, more than 5 million require medical treatment for marked mood and behavioral changes. Often symptoms tend to taper off with menstruation and women remain symptom-free until the two weeks or so prior to the next menstrual period. These regularly recurring symptoms from ovulation until menses typify PMS, premenstrual syndrome. Over 150 symptoms have been attributed to PMS. After complaints of feeling "out-of-control", anxious, depressed and having uncontrollable crying spells, the most common complaints are headache and fatigue. But symptoms may vary from month to month and there may even be symptom-free months. Although all women do not complain of all the symptoms at a time. The wonder of being a woman is that you always have a valid reason for your actions; PMS!

Characteristically symptoms may be both physical and emotional. They may include physical symptoms as headache, migraine, fluid retention, fatigue, constipation, painful joints, backache, abdominal cramping, heart palpitations and weight gain. Emotional and behavioral changes may include anxiety, depression, irritability, panic attacks, tension, lack of co-ordination, decreased work or social performance and altered libido.

Originally described in 1931 by an American neurologist, the grouping of symptoms has remained the same:

A- Anxiety: irritable, crying without reason, verbally and sometimes physically abuse, feeling "out of control", or Dr. Jekyl-Mr. Hyde behavior changes.

D- Depression: confused, clumsy, forgetful, withdrawn, fearful, paranoid, suicidal thoughts and rarely suicidal actions.

C- Cravings: food cravings, usually for sweets or chocolate; diary products including cheese, an on occasion, alcohol or food in general. This could also be explained logically as during the entire tenure of PMS, there may be a drop in your iron levels, causing you to crave for sweets.

H- Heaviness or Headache: Fluid retention leading to headache, breast tenderness, abdominal bloating and weight gain.

Apart from the regularity of symptoms seen prior to menstruation, there are certain elements which distinguish PMS from other disorders:

PMS may often be triggered by hormonal changes. It tends to begin at puberty, after pregnancy, after starting birth control pills, after hormone related surgery as hysterectomy or tubal ligation or around the onset of the menopause. In fact, it is not unusual for the PMS sufferer to confuse her symptoms with those of an early menopause.

Lifting of symptoms (including headache) with pregnancy, especially in the second and third trimester.

Heredity appears to be a factor although specific symptoms may differ between sisters or mother and daughters.

There is often an aura of increased activity prior to the worse symptoms of PMS or migraines. At this time, the woman may clean the house, function with little sleep, and feel euphoric. This is followed by the PMS symptoms, migraine, fatigue, exhaustion, depression and the inability to function. Women typically feel "out of control" at this time and this can cause the signs and symptoms of depression.

Causes
The exact cause of PMS, headaches and depression are unknown. In fact, it is not known why some women have severe symptoms, some have mild ones, while others have none. It is generally believed that PMS, migraine and depression stem from neurochemical changes within the brain. Hormonal factors, such as estrogen levels, had not been appreciated until recent studies.

The female hormone estrogen starts to rise after menstruation and peaks around mid-cycle (ovulation). It then rapidly drops only to slowly rise and then fall again in the time before menstruation. Estrogen hold fluid and with increasing estrogen comes fluid retention: many women report weight gains of five pounds premenstrually. Estrogen has a central neurologic effect: it can contribute to increase brain activity and even seizures. Estrogen can also contribute to retention of salt and a drop in blood sugar. PMS patients and migraineurs benefit from both salt and sugar restriction and a mild diuretic.

Postpartum Depression
A special form of PMS is the severe depression experienced after delivery. Most women experience a "let down" from the high hormone levels during pregnancy. Because of this, there is a normal amount of feeling "blue" immediately after childbirth. But the depth of depression experienced with postpartum depression is much deeper.

These individuals cannot tolerate the hormonal disruption to their nervous system: their actions may harm themselves or their infants. That is why the treatment of PMS in the postpartum period is first to replace the missing hormones. If unsuccessful, then other hormonal preparations can be included as well.

To conclude, we ought to remember that PMS is real -- and the prescription medication must address the woman’s need and the underlying hormonal imbalances.