Q. I know that something is wrong, for my life before my period is due is truly hell. Yet when I try to get help from my physician, I’m left frustrated and as unhappy as before my visit. Doesn’t anyone know anything about premenstrual tension?
A. Although much has been written and many studies conducted on premenstrual syndrome (PMS), the origins and best ways to treat it still defy classification. It may be that there is no single syndrome and that the physical, emotional and behavioral changes that occur just before menses may be due to a variety of factors that affect each woman in a unique fashion.
Since the symptoms vary, it is clear that it is important to document these premenstrual changes and to be certain other conditions that could produce similar complaints are not the real cause of the symptoms.
The symptoms of PMS are many and varied but can be placed into categories.
– Anxiety and irritability are among the “affective” symptoms.
– Decreased motivation and efficiency are some of the “behavioral” problems.
– The “autonomic” nervous system may provoke diarrhea, nausea and palpitations.
– Clumsiness, dizziness and tremors are among the symptoms from the “central” nervous system.
– “Dermatological” (skin) symptoms include acne and dry hair.
Most clinicians agree that to make a diagnosis of PMS, symptoms should begin during the luteal phase of the menstrual cycle, which occurs after ovulation and usually lasts for about 14 days during the last half of the cycle. The symptoms should disappear shortly after the start of menstrual flow, and there should be a symptom-free period during each cycle that lasts for at least one week.
Treatment should be attempted when the symptoms occur during almost every period and when there is some impairment in normal function. The symptoms that accompany menstruation are experienced by almost all women, but are severe in only 2 percent to 10 percent of women of reproductive age.
You may want to keep a symptom diary to aid the physician in understanding the frequency and severity of each symptom, when it occurs and what may have set it off. Daily morning weigh-ins are useful in calculating water retention problems. A complete record of this type should be kept during a minimum of two cycles.
Treatment will have to be individualized to be effective and may use non-drug strategies as well as medications. Relieving stress by changing lifestyles, particularly during the second half of the cycle, may be an important first step.
Eating nutritionally balanced meals also may help. These actions may help overcome some of the symptoms, so that consideration of possible medications for the remaining complaints may become a bit simpler. Properly used hormones, diuretics, antidepressants and anti-anxiety agents may offer the relief you’re seeking.
It is a long and difficult road since we don’t have all the knowledge we need, but the outcome may make it worthwhile.
———-
Write to Dr. Bruckheim in care of the Chicago Tribune, Room 400, 435 N. Michigan Ave., Chicago, Ill. 60611.
