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Female troubles. That time of the month. These are just a few vague euphemisms used today for the onset of premenstrual syndrome, or what we like to call “PMS.” They are polite reasons given when women feel a bit out-of-sorts due to physical, behavioral or emotional changes in the seven to 10 days before their period begins. Those changes can be a mild annoyance or downright debilitating.
This vagueness around the popular understanding of PMS lingers from the time of the Ancient Greeks, who did note some of the mood changes. But not until the 1930s was it even recognized as a disorder. Not until the 1950s did it even get a name. Since then, researchers have made strides in understanding several facts about the condition.
What You Might Not Know About Premenstrual Syndrome
By Pamela Perkins
PMS: The Basics
For one, it is real. It is a real diagnosis with a multitude of physical and emotional symptoms for women in their reproductive years that sometimes require professional attention. According to Harvard Medical School researchers, the most common symptoms are stomach bloating and breast tenderness, fatigue and forgetfulness, irritability and depression. When these kinds of symptoms seem to get progressively worse, a woman should see her physician to see if it is actually PMS, says Dr. William J. Moss, an OB-GYN with Women’s Health Services in Chattanooga. “If they’re just having a few mild symptoms, it’s not a problem. But if it’s becoming worse with time, then that needs to get checked out.”
Believe it or not, just because some PMS symptoms are present doesn’t mean a woman has the condition. Symptoms are common, but the term “PMS” is often used too freely outside of having an actual diagnosis. Although 80 percent of women in reproductive age experience some PMS related symptoms from time to time, only 20 to 30 percent can actually be diagnosed with the condition and the collection of symptoms that are severe enough to disrupt day-to-day activities.
Tracking these symptoms can be very helpful to doctors in determining whether a woman has actual PMS. Researchers, including those at the U.S. Department of Health and Human Services Office on Women’s Health, suggest tracking symptoms for at least two months using a calendar or chart. An example can be found on the website. The pattern of symptoms can be recorded on the chart and taken to a physician for confirmation.
The chart is also helpful in determining whether symptoms are PMS-related at all. A continuance of symptoms throughout the month could signal something other than PMS, says Dr. Manisha Patel, an OBGYN with Beacon Health Alliance. For example, she says, “If mood changes are occurring all throughout the month, then it’s not PMS.”
About Its Symptoms
What is not commonly known is that researchers have determined more than 150 symptoms for PMS. “Nobody gets all the symptoms,” says Dr. Moss. “But that’s all the more reason for a woman to keep track of whatever symptoms she gets. It’s such an enigma and there can be other underlying problems that need to be evaluated.”
The more common physical symptoms are bloating, weight gain, constipation, cramping, acne, breast tenderness, headaches, dizziness and food cravings. Common behavioral symptoms include mood changes such as irritability, depression, anxiety and crying spells.
While researchers continue to search for the exact cause of PMS and associated symptoms, many think the associated behavioral issues might be due to hormone level changes during a woman’s cycle. Effects of brain chemicals called neurotransmitters, such as serotonin, may also play a part in causing PMS.
What Will Alleviate Symptoms
Many women are not aware of possible treatments to help alleviate PMS issues. Changes in diet, for example, can help manage symptoms. The Academy of Nutrition and Dietetics recommends eating less salt to help decrease bloating. Less caffeine can sooth irritability. Less sugar, fat and alcohol will help with weight control. And foods such as whole grains, vegetables and fruits with high fiber can help control blood sugar.
Vitamins and mineral supplements are also known to help ease symptoms. Women may want to consider taking multivitamins with B6 folic acid, vitamin E, calcium, vitamin D and magnesium. According to the Mayo Clinic, there is some evidence that vitamin B6 in particular may help with breast tenderness and PMS related depression in some patients, but more research is needed to be conclusive.
“Exercise is another area in which some women may find relief because of endorphins, which are natural chemicals that can give a woman a sense of wellbeing and energy,” says Dr. Moss. Health and diet officials also suggest regular aerobic activities such as walking, biking or jogging to help with the physical as well as emotional symptoms.
PMDD —A More Severe Condition
Sometimes, treatment for PMS includes medications. But for the most part, medication is only required for the more severe form of PMS, called premenstrual dysphoric disorder or “PMDD.” PMDD affects 3 to 8 percent of women before menopause, and is marked by more exaggerated mood changes, most commonly irritability, depression and anxiety. Like PMS, PMDD will stop when menstruation starts. But it has a more prominent effect on day-to-day social functioning. And it’s also even more important to be sure that the symptoms are tracked to determine whether the patient has PMDD or another unrelated disorder that shares the same symptoms.
For that reason, PMDD is a rigid psychiatric diagnosis with specific criteria. And its treatments include anti-depressant medications, such as selective serotonin reuptake inhibitors (SSRIs), that increase serotonin levels in the brain to improve moods.
Both doctors Moss and Patel agree that any approach in treatment varies with the patient. Dr. Moss says several studies have been done to show that one treatment may be better than another, but he prefers a more individual-based approach. “What works in one woman may not necessarily work for another,” he says. “It’s a toughy.”
Don’t let “lady troubles” get you down. Talk to your healthcare provider if you have concerns about PMS or PMDD. He or she will be able to help you reach a diagnosis, and may help relieve some of the debilitating effects of your condition.
Pamela Perkins was a longtime staff reporter for The Commercial Appeal in Memphis, where she earned a Missouri Lifestyle Journalism Award and a Neighborhood USA Notable Award. She now lives in Chattanooga with her family.

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