No one knows what to make of PMS.
Doctors are stumped. Despite research around the world, no one has found a cause for premenstrual syndrome, a physical and emotional condition affecting millions of women every month for nearly half their lives.
PMS sufferers are mystified. Men-and some women who don’t have PMS-often don’t know how to deal with someone in the throes of PMS. But after years of being shelved behind other hot health issues for women, PMS may be poised to get its due.
Cases of PMS may be growing: Researchers now believe symptoms worsen with age, and the Baby Boom population is aging.
At the Center for Women’s Health at Charlotte, N.C.’s Presbyterian Hospital, questions about PMS top calls to the center’s information hot line.
In doctor language, PMS is the recurrence during the seven to 10 days before the onset of menses of a combination of verifiable physical and emotional symptoms. Three things separate PMS from other disorders, said Dr. Anna Stout of Duke University’s PMS Clinic in Durham, N.C.:
– Symptoms are cyclic-they happen every month at a predictable time.
– Symptoms are severe enough to interfere with normal activities or harm relationships.
– Symptoms decrease dramatically after menstruation begins.
National statistics estimate 5 percent to 10 percent of all women have such severe PMS that they cannot function for a week before their periods. Thirty percent to 40 percent have more moderate symptoms, but ones that still are noticed by family members or co-workers.
Despite this, PMS is still not recognized by many doctors, sufferers and researchers say.
“I’m surprised this isn’t taken more seriously,” said Lynn Paugh, assistant director of the Center for Women’s Health at Presbyterian Hospital in Charlotte. “I’m not sure who’s at fault. . . . If you can’t identify a cause, medical professionals are less likely to take any symptoms seriously.”
Still, it is hard for physicians to understand the nuances of a syndrome that has is highly individual.
“Women can react very differently to PMS, with different symptoms and different methods of coping,” Stout said. “There is no blood test, no X-ray you can use. It is a diagnosis related to a woman’s own reporting of her symptoms.”
And because there is no recognized cause that doctors can attack, they must treat the symptoms, many of which are emotional.
“It’s very important to stress to women that this exists and to stress to physicians that the symptoms are highly individual,” Stout said.
Several remedies have been suggested and tested to reduce PMS symptoms-among them Depo-Provera, a protesterone-based birth control method that in some women can suppress the menstrual cycle. Some women have been helped by nearly all of the various remedies, but none of them has been proved through scientific, verifiable study, say researchers. Some even have alarming side effects.
The latest rage among researchers is the use of the new antidepressants that trigger the production of serotonin, a naturally occurring brain chemical. The Duke PMS Clinic is one of 12 sites nationally that are testing the antidepressant Zoloft (Prozac also is being tested elsewhere) for use in alleviating PMS symptoms.
Some research suggests PMS may find its roots in the brain.
Last spring, the American Psychiatric Association classified severe PMS as a depressive disorder, the first time any form of PMS had been classified specifically as a medical condition. The classification referred to what the association called “premenstrual dysphoric disorder,” the most severe PMS, which affects about 5 percent of women, virtually incapacitating them for days.
The National Organization for Women denounced the move. Diagnoses of PMS may be based on “a prevailing cultural myth that expressions of anger or any sort of behavior that is not quite nice on the part of women is linked to their hormone cycles,” NOW spokeswoman Deborah Glenn of San Francisco said last spring. As a result, the diagnosis could be used against women in child custody fights and job discrimination suits.
“There is a tremendous amount of strong emotion connected to this,” Stout said. “Women think that if we stress research on a biological cause for PMS, that the `raging hormone’ debates will start up again, and women won’t be allowed to be airline pilots or hold important posts.”
