PMS: Often Joked About, But Not A Laughing Matter
PMS is often the brunt of jokes and is rarely taken seriously,
even by the women who have it. Yet for years it has been held accountable
for unpredictable, unexplainable, and unacceptable behaviors in women from moodiness
to murder. While up to four out of ten women under 50 have reported symptoms
of PMS, relatively few are actually affected by its closely related cousin,
premenstrual dysphoric disorder (PMDD). PMDD has recently been listed as an
official psychiatric diagnosis; this further clouds the distinctions between
normal and abnormal. Dr. Donnica discusses what PMS is, what it isn't,
how to diagnose it, how to treat it, and how to live with it. She also offers some advice to men about how to best be supportive of the women
in their lives afflicted with various premenstrual symptoms, whether they have
PMS, PMDD or just another routine period.
What is PMS?
PMS is a chronic, cyclic mood disorder distinguished by a set of physical,
psychological and emotional symptoms that affects approximately four out of 10 women
of childbearing age in the second half of their menstrual cycle. While the
exact cause of PMS symptoms is not known, many physicians attribute them to
fluctuations in female hormone levels or other bodily chemicals, including pituitary
hormones, prostaglandins, or certain neurotransmitters such as serotonin in
the brain. For example, many studies of PMS patients show a trend toward decreased
levels of serotonin premenstrually. Some researchers describe the cause of
PMS as "an abnormal response to normal endocrine changes". Other research has
suggested theories that in some women, PMS may be related to hypoglycemia
(abnormally low blood sugar); hypothyroidism (abnormally low levels of thyroid
hormones); or a dietary deficiency of B vitamins, calcium or magnesium. In addition
to these factors, lifestyle may also play a significant role in PMS: PMS symptoms
appear to be most troubling in women who smoke, have stressful lives, rarely
exercise, get insufficient sleep, or who have a poor diet. In fact, PMS symptoms
may be triggered or worsened by a high intake of caffeine, alcohol, salt, red
meat or sugary foods (especially chocolate). . .despite the fact that many women
with PMS have cravings for these substances (especially chocolate). In some
women, the use of oral contraceptives has worsened or produced symptoms of PMS;
in other women, however, starting or switching birth control pills has reduced
or eliminated PMS symptoms.
Women between ages 25 and 34 are more than twice as likely to experience PMS
than those between ages 35 and 44. The good news is that PMS disappears once
menopause is established, although many women describe going through menopause
as having "constant PMS"!
In recent years, there has been some controversy in the medical community about
the definition of PMS. This is because premenstrual discomfort is fairly
common among women of childbearing age, affecting about 3 out of 4 of all menstruating
women, making it quite "normal". However, fewer than 8 women out of 100 have
premenstrual symptoms that are severe enough to disrupt their personal relationships
or interfere with their normal daily activities. Some doctors feel that this
latter criterion is essential to make the diagnosis of "true PMS". Other physicians
feel that whether or not a woman has PMS or simply "menstrual discomfort" is
based upon the woman's subjective view of her own circumstances.