PMS {Premenstrual Syndrome}
By Kimberley Forthofer, ARNP – Kalispell OB/GYN
PMS…..It’s expected, but that doesn’t make it any more tolerable. In fact, this may very well make it worse as you live in fear of the two weeks out of the month you will not be yourself, which you know will impact your work, your relationships, and most detrimentally, your sense of well-being.
It’s estimated that premenstrual syndrome (PMS) affects only 3-8% of women, though this is largely underestimated since many women do not seek treatment for PMS. There are varying degrees of severity of PMS and the symptoms can also be varied. Symptoms of PMS may include mood changes with sudden onset of irritability, depression, anxiety, tension and anger, sensitivity to criticism, low self-esteem, fatigue, as well as physical symptoms of overeating, breast tenderness, bloating and joint and muscle aches. This is a broad list of symptoms, but they usually occur in a very predictable pattern when related to PMS; most commonly starting in the 1-2 weeks prior to a woman’s period and then resolving within the first 1-3 days of starting a period.
Some women fear that they have a “hormonal imbalance” that is causing their PMS symptoms. Several studies have researched this possibility and confirmed that women with PMS have the same hormonal characteristics as women without PMS; however, women with PMS likely have an abnormal response to the normal hormonal changes that occur throughout the menstrual cycle. Estrogen, which is in abundance during the first part of woman’s menstrual cycle, drops drastically at the time of ovulation, which occurs in the middle of the normal menstrual cycle. The level of estrogen remains low throughout the remainder of the normal 28 day cycle and gradually increases with the onset of the next period. Estrogen levels are directly related to the “feel good” neurotransmitter, serotonin. Neurotransmitters are chemicals that send messages to our brain and body to carry out specific functions. When estrogen levels are high, so are serotonin levels. When women with PMS have a drop in estrogen they have a heightened response to the lower serotonin levels that are now present, leading to symptoms of depression, irritability, body aches and fatigue, just to name a few.
Better understanding and recognition of PMS has led to improvements in the treatment of PMS. Medications called serotonin selective reuptake inhibitors (SSRIs) have proven the most benefit in the treatment of PMS. A common medication, Prozac, is an SSRI, which can provide women relief from the symptoms of PMS. Medications to treat PMS can be taken cyclically for 1-2 weeks out of the month or on a daily basis. Vitamins and mineral supplements were studied in the treatment of PMS, however, none showed a large benefit. Even so, some evidence suggests that vitamin B6, with a maximum dosage of 100 mg a day, may be beneficial for some women. Birth control pills can also be a treatment for PMS. The type of birth control pill is often adjusted specifically for the treatment of PMS. There are a variety of formulations of birth control pills and some are specifically marketed for the treatment of the most severe form of PMS known as Premenstrual Dysphoric Disorder (PMDD). Risks and benefits of birth control pills can be discussed with your health care provider to determine if this is the right treatment option for you.
Lifestyle modifications can also lead to improvement of symptoms. Women who smoke are at higher risk for PMS, as are women who drink excessive amounts of alcohol. So quit smoking and limit alcohol intake to no more than 1 drink per day. Regular exercise also provides benefit as it increases the release of serotonin, dopamine and norepinephrine.
PMS is often joked about and made light of, but for many women it is not a laughing matter. PMS is real and can be serious. Women lead busy lives as workers, wives, sisters and mothers and the demands are already high. When you deal with the symptoms of PMS in addition to the day to day stressors of life, it can often be overwhelming. Talk to your health care provider.
More information on premenstrual syndrome can be found at Mayo Clinic keyword premenstrual syndrome (PMS) and through the American College of Gynecology (ACOG) link
** Kimberley Forthofer, ARNP joined Kalispell OB/GYN in July of 2013. She was raised in Whitefish and returned to the Flathead Valley after working for 4 years as a primary care provider in Washington. She offers a wide range of experience in primary care as well as women’s health and her clinical experience includes both acute and chronic care. She and her husband, Joe, have two children and enjoy all the outdoor recreational opportunities Montana offers.