Your A-Z Guide to PMS

PMS-like symptoms aren't always related to your period. Understand your symptoms and get relief!


Enlarge Image Don't let PMS stop you from enjoying life.

For some women, the 10 days to two weeks before their period starts has a Jekyll and Hyde effect. One day you're feeling fine, and the next you're emotional, bloated, and can hardly resist chocolate and potato chips. Many women think that PMS is something they have to learn to live with. But doctors and, more important, women themselves have found natural, easy ways to make the time before their period less difficult.

Doctors and researchers have been investigating PMS for more than 70 years, but nobody has been able to devise a test or agree on a cause. PMS is difficult to study because every woman has a different chemical makeup.

More than 150 physical and mental symptoms, from breast tenderness and bloating to panic attacks and irritability, can suggest PMS. The one thing the experts agree on is that PMS is real. "Reassurance and understanding that this isn't all in your head goes a long way to help relieve PMS," says Dr. Steven R. Goldstein, professor of obstetrics and gynecology at New York University. "There is a physiological reason you feel the way you do. It's not just a fluffy diagnosis."

PMS is most likely caused by one, two, or a combination of three things -- a hormone, chemical, or nutritional imbalance. Although studies of PMS remedies aren't conclusive, anecdotal evidence from women suggests that changes in diet, exercise, and relaxation can greatly reduce symptoms. But remember: Every woman has a different hormonal system, so what works for your friend may not make you feel better at all.

Chart Your Symptoms

Because PMS symptoms can indicate other illnesses, it's important to rule out other causes of your monthly misery. The easiest way to do this is to keep a symptom chart.

Mark the days on a calendar that you don't feel well. Also note your symptoms, such as bloating, headache, and anxiety. Keep a record for two to three months to see if symptoms cluster around your period. If it's PMS, your discomfort should occur during the two weeks before your period and go away after your period starts.

Renee Dorazio, a nursing instructor in Madison, Wisconsin, got firsthand experience in the power of charting. About six years ago, the 38-year-old began getting migraines. After six or seven months of headaches, some so severe that she couldn't work, she went to her doctor for tests. When a blood sugar and thyroid test came back normal, the doctor suggested that Renee record her headaches. "After a couple of months I realized that the headaches happened a week to the day before my period," she says. "It never dawned on me that they could be caused by hormones."

Food & Your Mood

Some experts believe that low blood sugar plays a big role in PMS. During the premenstrual phase, glucose, or blood sugar, levels may drop. The brain needs glucose to function properly. Low glucose can cause headaches, depression, and confusion.

Yet another theory contends that poor nutrition leads to, or exacerbates, PMS. Some doctors think that women with PMS don't get enough calcium, magnesium, or vitamins E or B6. Foods often flagged as PMS triggers are white sugar and flour, caffeine, alcohol, and fatty foods.

Consider these tips for trying to ease your PMS symptoms by analyzing when and what you eat:

  • Eat often. During PMS, many women have low blood sugar. When blood sugar drops, cortisol is released, which may make you nervous, jittery, and anxious. As blood sugar plummets, you find yourself craving cookies, chips, and just about anything fried in grease.To avoid this roller coaster, eat at least every four hours. Most doctors recommend eating three small meals and two to three snacks a day.
  • Choose slow-burning foods. So what should you eat every four hours? Pick foods that your body processes slowly. Lean protein, such as chicken, turkey, soy foods, and fish, and above-the-ground vegetables, such as broccoli, cauliflower, and peppers, are all good choices. Try not to eat foods that can raise blood sugar quickly, such as white flour and sugar, potatoes and carrots. Whole grains also are a healthy choice. A good rule is to look for brown foods at the grocery or health food store, such as brown rice, oatmeal, and whole wheat.
  • Skip the salt. Hiding the salt shaker can also help control PMS. Dr. Goldstein puts all of his PMS patients on low-salt diets. Salt encourages your body to retain water. The fluid retention can cause bloating all over your body. Water retained in the brain can cause headaches, and extra water in the breasts can make them tender.
  • Kick caffeine and alcohol. What you drink can make your PMS better or worse too. "Beverages can be an Achilles' heel for women with PMS," says Dr. Susan Lark, a specialist in preventive medicine and clinical nutrition. Soft drinks are packed with sugar. Alcohol is processed into sugar by your body, and it also depresses your nervous system, which affects mood. Women who drink alcohol often complain of anger as a PMS symptom. The caffeine in your morning coffee or afternoon soda can cause breast tenderness, mood swings, and anxiety. A study of more than 200 college women found that 60 percent of those who drank more than 4-1/2 cups of caffeinated beverages a day had severe PMS symptoms.
  • Turn on the tap. Instead of coffee or soda, guzzle water. Some women fear that drinking more water will add to bloating, but adding water helps your body eliminate bothersome fluids. When you're dehydrated, your body hangs onto water, making bloating worse.
  • Consider supplements. In addition to the right food and drink, some vitamins, minerals, and supplements have given women relief. A 1998 study of more than 400 women in the American Journal of Obstetrics and Gynecology found that 1,200 milligrams of calcium supplement each day cut PMS symptoms almost in half after three months. The B complex vitamins, which are involved in more biochemical reactions in the body than any other vitamin, seem to improve mood and reduce bloating. To help soothe nerves, some women take magnesium. Evening primrose oil and other essential fatty acids, such as borage or flaxseed oil, are sometimes recommended by doctors to reduce cramping and relieve breast tenderness. All are sold at most health food stores.
Work Out to Feel Better

Doctors don't know for sure why exercise helps PMS, but some believe that it helps stabilize blood sugar. Getting active may also increase endorphins, the body's relaxing hormones that are 500 times more potent than morphine. A brisk 20- or 30-minute walk three times a week seems to be enough to help most women.

Exercise is one of the first things that the staff at PMS Access in Madison, Wisconsin, recommends to the more than 2,000 women who call every day with questions on how to relieve PMS naturally. Cofounder Marla Ahlgrimm, a registered pharmacist, says exercising helps women elevate their mood and ease anxiety.

Run a hot bath and soak for 20 minutes, walk the dog around the block without the kids, or check out that yoga class at the gym. For most women, 15 to 20 minutes by themselves is enough time to clear their heads.

PMS or Perimenopause?

Many women notice that their PMS gets worse with age. Although experts aren't sure why this is, some believe that it's related to the hormonal changes that happen prior to menopause. As the body prepares to shut down reproduction, it produces less and less estrogen and progesterone.

The average age of menopause is between 49 and 54, but women can be in perimenopause for as many as 10 years before menopause. "Menopause is really ovarian retirement," explains Dr. Christine Green, a family physician in Palo Alto, California. "But the ovaries don't quit all at once, they just go on vacation."

But vacationing ovaries can mean irregular periods, anxiety, insomnia, weight gain, and mood swings. Sometimes it's difficult to distinguish perimenopause from PMS. Because both conditions are treated symptomatically, it's not imperative to decide which you have. In fact, you may have both. "When I see perimenopausal PMS, I call it PMS," says Dr. Green.

Changes in diet and exercise seem to help both perimenopausal and PMS symptoms. However, in perimenopausal women, emotional symptoms might not respond as readily to natural remedies. Antidepressants or other drugs might be needed to help you feel better.

Beyond Self-Help

If diet and exercise don't do the trick, it may be time to try something else. Your doctor might suggest a low-dose birth control pill. Some doctors believe that an imbalance of the sex hormones estrogen and progesterone causes PMS. Too much estrogen can make you anxious, irritable, and confused. Too much progesterone, a natural relaxant, can lead to depression. The pill can regulate your menstrual cycle and keep your hormone levels steady throughout the month.

Or ask your doctor about natural progesterone, which is sold over the counter. Its use in treating PMS is somewhat controversial, but some women swear by it. Clinical study results have varied, with some finding progesterone effective and others concluding that it had no effect on symptoms at all. Women who have taken natural progesterone report that it has a calming effect.

However you treat your PMS, remember you're not alone. Finding a person who believes that what's going on with you is real will help you feel more in control.


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