Debilitating Part 1

PMS, a.k.a. premenstrual syndrome...I thought I would break this post up into at least two parts. Today will be just a recap of what PMS, and PMDD are. I'll talk about some of the symptoms and possible ways to treat PMS/PMDD. Then tomorrow I will talk about how this pertains to me. This post has a bit of a clinical feel to it - sorry.

Wikipedia defines it as:

"a collection of physical, psychological, and emotional symptoms related to a woman's menstrual cycle. While most women of child-bearing age (about 80 percent) have some symptoms of PMS,the official definition limits the scope to having symptoms of "Sufficient severity to interfere with some aspects of life." Such symptoms are usually predictable and occur regularly during the two weeks prior to menses. Generally, symptoms may vanish both before or after the start of the menstrual flow.

While some experts claim that virtually all menstruating women experience PMS, a more recent and intermediate position shows that only a small percentage of women (2 to 5%) have significant premenstrual symptoms that are separate from the discomfort associated with menstruation.

For some women with PMS, the symptoms are so sever that they are considered disabling. This form of PMS has its own psychiatric designation: premenstrual dysphoric disorder (PMDD)."

The symptoms listed, on more than one website and in many books, for PMS are as follows: Abdominal bloating, abdominal cramps, breast tenderness or swelling, stress or anxiety, trouble falling asleep (insomnia), joint or muscle pain, headache, fatigue, acne, mood swings and worsening of existing skin disorders, and respiratory (for example allergies, infection) or eye problems.

Many treatments are suggested for PMS, diet or lifestyle changes, and other supportive means. Medical interventions are primarily concerned with hormonal interventions and use of selective serotonin reuptake inhibitors (SSRIs).

So, in a nut shell, therapy if you need it, aerobic exercise, better diet (less caffeine, sugar and sodium and more fiber), enough sleep, some supplements like calcium, vitamin E, vitamin B6, magnesium and tryptophan have all been shown to help. Then there are the SSRIs that I don't know much about and hormones. Diuretics to help with water retention and ibuprofen have also been used to treat symptoms of PMS. On a more natural note, some sites claim that evening primrose oil helps also but it lacks the scientific support.

PMDD is a severe form of PMS that afflicts 3 to 8 percent of women. Again, this is taken from Wikipedia:

PMDD is premenstrual syndrome (PMS) that is so severe it can be debilitating due to either physical, mental or emotional symptoms. Treatment is recommended because PMDD interferes with the sufferer's ability to function in her social or occupational life. The cardinal symptom--surfacing between ovulation and menstruation, and disappearing within a few days after the onset of the bleeding--is irritability (PMID 11571794). Anxiety, anger, and depression may also occur. The main symptoms, which can be disabling, include[3]

* feelings of deep sadness or despair, possible suicide ideation
* feelings of tension or anxiety
* panic attacks
* mood swings, crying
* lasting irritability or anger, increased interpersonal conflicts
* apathy or disinterest in daily activities and relationships
* difficulty concentrating
* fatigue
* food cravings or binge eating
* insomnia or hypersomnia
* feeling "out of control"
* increase or decrease in sex drive
* increased need for emotional closeness
* physical symptoms: bloating, heart palpitations, breast tenderness, headaches, joint or muscle pain

Five or more of these symptoms may indicate PMDD. Symptoms occur during the week before the menstrual cycle and disappear within a few days after the onset of the bleeding.

Most PMDD is treated, according to my doctor, with anti depressants like Prozac, Zoloft, Paxil, etc. This portion, thanks again to Wikipedia supports what she has told me:

Lifestyle changes such as regular exercise and a well balanced diet may ameliorate some of the effects of PMDD. There is some evidence that vitamin B6 in doses up to 100mg can alleviate symptoms.[10] Certain SSRIs provide relief as well.[11] The U.S. Food and Drug Administration (FDA) has approved four medications for the treatment of PMDD: Fluoxetine (also known as Prozac), was approved by the U.S. Food and Drug administration for PMDD in 2000. Sertraline (Zoloft) was approved in 2002, Paroxetine HCI (Paxil) and also Escitalopram Oxalate (Lexapro) has also been approved by the FDA. The patent for Fluoxetine has expired, but Eli Lilly was able to obtain a new patent for its use in the treatment of PMDD, which has since marketed heavily under the trade name Sarafem.[12] However Fluoxetine is now available as a generic in the same doses used in Sarafem, with the generic price generally a fraction of the cost for branded Sarafem. L-tryptophan, a serotonin precursor, was found in two studies to provide significant relief when supplemented daily in a large dose of (six grams) per day.[13]

Another alternative is hormone therapy; the simplest treatment is the Pill, which may lessen or even eliminate symptoms. The Pill can also make some women's symptoms worse as it contains progesterons and many women with PMS and particularly PMDD are intolerant to progesterones (their own and synthetic ones). There is evidence to show that progesterones may be at the root of their PMDD and PMS (Watson et al 1989; Leather et al 1999; Studd et al 2004).

The only complete cure is removal of the ovaries or menopause. However, hormone therapy is usually then needed to mimic natural hormone levels.

After talking with my doctor extensively, she told me that I have PMDD. I will discuss more tomorrow just how much this had affected my life.