by
Dr. Tali Shenfield, Clinical Psychologist
Premenstrual syndrome or PMS is widely known, but often misunderstood by the general public. In spite of medical evidence to support the validity of both the physical and psychological changes that occur as a result of PMS, the effects of this syndrome are often dismissed and sometimes even ridiculed.
In truth, there are several conditions triggered by a woman's menstrual cycle that may have a dramatic impact on her ability to cope with daily life. Mood changes, fatigue and physical symptoms strike about 75% of all menstruating women, ranging in intensity from mild to severe.
Premenstrual Conditions and Symptoms
A premenstrual condition is characterized by symptoms that come about during ovulation. The first day of menstruation is the day the period begins, so the defining premenstrual time is 14 days before the period starts (the start of ovulation). Therefore, a premenstrual condition has symptoms which occur during the 14 days before menstruation and subside or disappear once bleeding begins.
PME – Premenstrual Exacerbation
PME is premenstrual exacerbation, which amplifies or worsens the symptoms of another illness or disorder (usually a mood disorder). This begins in the 14 days before the period starts and relents once the period arrives.
PMS – Premenstrual Syndrome
PMS is characterized by emotional and physical symptoms that coincide with the onset of ovulation. Emotionally, women may be irritable, easily angered, anxious or depressed. Some women may feel overwhelmed with life's many demands, or succumb to feelings of sadness. They may be susceptible to feelings of rejection or feel shunned or slighted. Many women withdraw from social and family situations when experiencing PMS.
Physical symptoms also accompany PMS. Fatigue, a bloated stomach and tender breasts are the most well known symptoms, but women may also experience headaches, body aches and swelling of hands and feet. A change in appetite may result in overeating or food cravings. The woman may also be prone to hypersomnia, a condition which causes excessive sleepiness during the daytime or regular waking hours.
PMDD – Premenstrual Dysphoric Disorder
When the emotional symptoms of PMS are very severe and disruptive, it may be diagnosed as PMDD. This condition is not nearly as common as PMS, occurring in only 3% to 8% of the menstruating population.
While PMDD may present itself during the teenage years, this is rare. It usually starts to appear when a woman is in her 20's or 30's. Over time, the condition develops and becomes more severe. The primary symptom of PMDD is irritability, with many women also experiencing mood swings, anxiety and possibly depression.
Premenstrual Dysphoric Disorder is classed as an affective disorder and requires more extensive treatment tha
PMS. Women who have a family history of premenstrual mood disorders are at risk of developing PMDD. A previously diagnosed mood disorder, such as anxiety or stress disorders, may also increase the risk of this condition.
PMDD is most easily recognized because the symptoms interfere with a woman's ability to live a regular life. Symptoms can become quite severe, making work and family relationships difficult. A partner or spouse may not appreciate the depth of the disorder, and as a result, be unable to provide appropriate emotional support.
Diagnosis and Treatment
PME, PMS or PMDD require a full physical and mental evaluation to reach a proper diagnosis. PME has an accompanying illness and intensifies the symptoms during the premenstrual cycle. It is imperative to discover the primary illness, since symptoms may be much less noticeable during the first two weeks of the menstrual cycle.
PMS, while often manageable, should not be dismissed. It may be difficult for the woman coping with symptoms to appreciate how severe the symptoms are. Under direction of a health care provider, symptoms and their severity can be recorded each day to determine if the woman is suffering from PMS, PMDD or another illness with similar symptoms.
Charting the variation in moods and symptoms may also be a useful practice in treatment. When distinct patterns appear, a woman can anticipate symptoms and develop strategies to cope.
The course of treatment for a premenstrual condition does not usually necessitate medication, although some herbal remedies have been found useful. There is no “one size fits all” treatment, but it usually includes reviewing diet and lifestyle to make adaptations that will help the symptoms recede.
Psychotherapy is also quite beneficial for women suffering from PMS and PMDD. In many cases, including family members, partners or spouses in the therapy can be beneficial to help the woman build a strong support network that is educated and informed.
When medications are deemed necessary, SSRI's (selective serotonin reuptake inhibitors) in low doses can ease the emotional intensity as well as many of the physical complaints of PMS or PMDD. Women tend to respond quickly to the medication, and results are apparent within days.
Women with PME, however, have a different treatment experience. First, the primary mood disorder must be diagnosed and treatment must be adjusted during cycles of PME. Some medications are not effective with dosage changes, and may not be needed at all during non-PME phases. Only a qualified professional can make the diagnosis and determine the best treatment for the woman's overall health and welfare.
Finding Help
Some women suffer through varying degrees of premenstrual symptoms without seeking help. In fact, “It's just PMS” tends to be an accepted mantra among women struggling with irritability or emotional outbursts that harm family relationships. Left untreated, PMS can interfere with work, social interaction and a woman's ability to enjoy all life has to offer, including quality time with family, children and friends.
Mood swings, emotional imbalance or increased sensitivity should not be dismissed, nor do they need to be a dominant force in a woman's life. The first place to look for help is a family physician, nurse practitioner , health care clinic or even a hotline. Once initial blood work and other tests are complete, a referral will be made to an appropriate professional for a more in-depth diagnosis.
PMS, PME and PMDD are very real conditions that, left untreated, will reduce a woman's quality of life. Proper diagnosis and treatment, however, can make the symptoms manageable and give a woman back a sense of control as well as relief from the symptoms of premenstrual conditions.