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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.

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 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. 

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