Eric still remembers the first time he was exposed to premenstrual syndrome.
The Altamonte Springs, Fla., computer operator and his fiancee, Jo Ann, 24, were sitting on his couch when he started wrestling with her and tickling her.
“She was laughing and telling me to stop,” recalls Eric, 25, “but I continued to do it.
“Then she just got up and walked across the room and wouldn’t speak to me for 30 minutes. Nothing like that ever happens normally.”
“He was shocked,” says Jo Ann, who works in marketing and promotions in Orlando. “I said, `Sorry, guess I just have PMS right now.’ “
The couple don’t want their last names used because, well, PMS is a little awkward to talk about. To joke about, no. But to talk about, yes — especially when it comes to the tension that women’s hormones can inflict on a relationship.
But couples can learn to deal with PMS if they talk to physicians, counselors — and each other.
Alice MacMahon, director of The Center for Women’s Medicine at Florida Hospital, has been counseling PMS sufferers and the men who love them for 10 years. She also has written a book, “Women & Hormones,” which addresses PMS as well as menopause and other hormonal hot topics.
Often, the guy is the one who suggests counseling, MacMahon says. “Most men really do want to understand.”
What they want to understand are the sadness, irritability, anger, tearfulness, anxiety, or depression that characterize PMS for many women. Then there are the physical symptoms — breast tenderness, muscle and joint pain, abdominal bloating, headaches, constipation or diarrhea, increased thirst, cravings for sweet or salty foods and fatigue. Some women experience insomnia or difficulty concentrating.
Some women report symptoms during and after menstruation.
“Premenstrual syndrome” is a misnomer, MacMahon says. “A syndrome is a collection of symptoms that are pretty much standard. But PMS varies so much from one individual to the next.”
The wide variation in symptoms is just one reason that some medical professionals — and many women — don’t consider PMS a legitimate condition.
Another reason is that no exact cause has been pinpointed.
“But the same thing could be said about breast cancer,” MacMahon notes, “and we don’t discount that.”
PMS can set in 10 to 14 days before menstruation. And it affects most women, MacMahon says, to one degree or another.
“It’s a bell curve pattern,” she says. “Some people aren’t affected at all, some are affected tremendously and most are in the middle.”
Which is where Jo Ann puts herself. “I don’t go into a rage; I don’t throw things,” she says. She’s more likely to bawl over a sappy TV commercial or to get irked at Eric.
Most women have symptoms for only about five days, says Dr. Diana L. Dell, an assistant professor of obstetrics and gynecology at Duke University, in Durham, N.C.
It’s the women at the far end of the bell curve — the ones whose symptoms are severe — who generally seek help, MacMahon says.
“Most women report that the physical symptoms are something they can put up with, but the emotional symptoms are unendurable, both for them and for their families,” she writes in “Women & Hormones.”
For severe PMS, in which women become suicidal, for instance, medication to suppress ovarian function — and even surgery to remove the ovaries — may be recommended, says Dr. Randall Loy, a reproductive endocrinologist in Orlando.
Meanwhile, research published in the New England Journal of Medicine shows that the anti-depressant Prozac can significantly relieve the tension and the irritability that some women experience with PMS.
But the vast majority of women can alleviate their symptoms without medication or surgery, MacMahon says. All they need to do is make dietary changes, exercise regularly, manage stress — and communicate with their spouses.
Whether the PMS is severe or moderate, it’s important that husbands learn what it’s all about. That may include talking to their wives’ physicians or doing some reading.
“The spouse needs to know that it’s (the irritability, anger or sadness) not about their relationship, it’s about how stressed that woman is feeling right now,” says Dell, who is president of the American Medical Women’s Association. “It’s about a time of being what I call `biologically more vulnerable.’ “
However, a caveat: Beware of blaming PMS for everything.
“People get into a pattern of having difficulties in a relationship, making up and saying, `Oh, I was just premenstrual,’ rather than addressing the fact that there really is something in that relationship that needs work,” Dell says.
Or husbands may discount their wives’ legitimate concerns about the relationship by saying, “Aw, she’s just got PMS.”
Either way, PMS becomes a convenient excuse for evading responsibility.
“When I see someone come in and say, `I have PMS,’ I get her to keep a diary,” says Dell. “Without a diary done on a day-to-day basis, you don’t really know that PMS is what’s happening.”
A diary can be a journal entry noting any PMS symptoms or a notation made on a calendar. It’s best to keep track for three months, MacMahon says, to determine if there’s a pattern to the symptoms.
If the woman’s symptoms are truly related to her menstrual cycle, there are some steps she and her husband can take to cope with the condition.
For instance, husbands can be supportive as their wives reduce their intake of caffeine, sugar, salt and alcohol.
If he’s craving a slab of chocolate cake, he can buy one at lunch instead of expecting his wife to join him in this indulgence at dinner.
“The very things that women who suffer from PMS may crave — sweets, salty foods, caffeine and alcohol — are the very things that may intensify the problem,” MacMahon writes in “Women & Hormones.”
Most PMS sufferers swear by exercise as a remedy.
“Exercise stimulates the brain to produce chemicals which enhance our sense of well-being,” MacMahon writes. “In fact, a deficiency of endorphins, the `feel good’ brain chemicals, is one theory of the cause of PMS.”
MacMahon recommends aerobic exercise — something couples can do together — for the first weeks of the menstrual cycle.
For the last two weeks, when PMS occurs, she suggests stretching and flexibility exercises, “which seem to assist the cells which tend to retain fluid during this time.”
In addition, gentle stretching is kinder to swollen, tender breasts than bouncing, thumping, high-impact aerobics.
Probably the most important area for couples to work on in relieving PMS is stress management.
“Stressors come in three forms: physical, psychological and social,” MacMahon writes. “Some examples of physical stressors might be excessive weight, poor eyesight, poor nutrition, tense back muscles, alcohol or drug abuse or an injury.
“Psychological stressors would include anger, fears, anxieties and frustration. And social stressors include yelling children, heavy traffic, ringing telephones and even Christmas preparations.”
It’s up to the woman to take care of physical stressors — eating right, getting appropriate medical treatment. It’s also important for women to manage their stress levels by saying no to any activity that makes more work for them during their PMS days. That may mean postponing the dinner party you had planned or rescheduling that business trip.
Spouses can be a big help in relieving the psychological and social stressors. For example, “at a time when someone’s biologically vulnerable,” Dell says, “that may not be the time to talk about something that’s a source of contention between the couple.”
But it’s the perfect time for Dad to forgo that football game and take the kids on an outing, to take over some of the household tasks normally performed by Mom, to spend more quiet time with his wife or to fade into the woodwork.
The key for men is learning what their wives need at this time of the month. Some women want more hugs, more time together; others want more time by themselves.
Talk about her needs at an appropriate time — not when she has PMS.
And remember: Forewarned is forearmed. Even men who are knowledgeable about PMS and its effects can be taken by surprise when their wife’s mood suddenly shifts. It’s not like they sit around watching the calendar every month. Usually a few simple words can alert your spouse that it’s time for him to slip into “PMS relief mode.”
Jo Ann and Eric have a signal. She just tells him, “Sorry, I’m hormonally challenged right now.”
