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Women’s Reproductive Health: PMS

Ann Witt, M.D., and Natalie Staats Reiss, Ph.D., edited by Benjamin McDonald, MD

A number of other reproductive health concerns besides cervical and uterine cancer impact women. These female-specific concerns include: problems with the onset of the menstrual cycle and ongoing hormonal fluctuations; organ-specific conditions such as benign fibroid tumors; and the final hormonal changes that occur with the onset of menopause.

Premenstrual Syndrome (PMS):

upset womanPMS is a condition where physical and emotional symptoms, such as tiredness, food cravings, bloating, sleep changes, body aches, and breast tenderness, develop just prior to the onset of a woman's menstrual cycle. These symptoms resolve at the time of menstrual bleeding. PMS is a very common syndrome, with most women of reproductive age developing these symptoms at some point during their life. Premenstrual Dysphoric Disorder or PDD is a more severe form of PMS. In PDD, women have mood symptoms that occur prior to menses and resolve within 3 days of the beginning of the menstrual cycle. To meet the criteria for the diagnosis of PDD, a woman must have either depression, anxiety, sudden changes in her mood, or severe anger and irritability that interfere with work, school or daily relationships that occur exclusively during the premenstrual period. An individual may also have difficulty concentrating, experience changes in their sleep patterns or appetite, and notice a decrease in energy. By definition, women with PDD do not have mood symptoms (i.e. anxiety, depression, irritability) during the rest of the menstrual cycle.

Diagnosis:

If a woman suspects that she has PMS or PDD, she should chart her mood and other associated symptoms on a calendar for at least two menstrual cycles.

Typically, symptoms like food cravings, fatigue, anxiety, and depression are listed on the chart, and a woman can check off which days of the month they are present. The dates of a woman's menstrual cycle are also recorded on the calendar. Once a pattern between symptoms and the onset of the menstrual cycle has been identified, the symptoms can be appropriately treated.

Treatment and Controversies:

Lifestyle changes, such as reducing caffeine, sugar, and sodium intake, are usually the first treatment recommended for PMS and mild PDD. Women with PMS and PDD should also engage in regular exercise. In order to determine which lifestyle changes have a positive impact, the effects of these strategies should be monitored on the symptom chart described above for at least two months (keeping all of this information on the same calendar makes it easier to identify benefits). If the lifestyle changes are not beneficial, then some women try vitamin B6 supplementation as well as the regular use of calcium carbonate.

The Selective Serotonin Reuptake Inhibitor (SSRI) class of anti-depressants (e.g., Paxil, Prozac) remains the first choice of medication to treat the depressive symptoms of PMS and PDD. As their name suggests, these types of medication are thought to work by slowing down the reabsorption of serotonin (a neurotransmitter or chemical messenger used in the brain and nervous system) by neurons (cells of the brain and nervous system). Because serotonin reuptake is prevented, serotonin molecules end up having more of an opportunity to positively impact parts of the brain that control mood. Again, to determine whether a particular medication benefits her mood, a woman can keep a chart of daily depression symptoms for the first 3 cycles of treatment. Typically, women take SSRIs on a daily basis. However, some studies suggest that women may still obtain relief by taking the medicine only during the weeks of their PMS or PMDD symptoms.

Sometimes, anti-anxiety medications or hormonal therapy may be needed if other types of therapies are not helpful. Some women also gain relief from bloating and weight gain by using the diuretic spironolactone. A beneficial medication should be continued for at least 9 to 12 months before attempting to decrease dosages or discontinue in consultation with a doctor.

Prognosis:

In general, the symptoms of PMS and PDD tend to remain at the same level of intensity until menopause. The various treatment options described above don't eliminate the condition entirely; rather, they help to control the symptoms. For most women the symptoms of PMS and PMDD resolve at the time of menopause.