Edward Lichten, M.D.,PC
Premenstrual Syndrome: PMS is a disorder characterized by a set of hormonal changes that trigger disruptive symptoms in a significant number of women for up to two weeks prior to menstruation. Of the estimated 40 million suffers, more than 5 million require medical treatment for marked mood and behavioral changes. Often symptoms tend to taper off with menstruation and women remain symptom-free until the two weeks or so prior to the next menstrual period. These regularly recurring symptoms from ovulation until menses typify PMS, premenstrual syndrome.
Originally described in 1931 by an American neurologist, the grouping of symptoms has remained the same:
Aside from the regularity of symptoms seen prior to menstruation, there are certain elements which distinguish PMS from other disorders:
*PMS may often be triggered by hormonal changes. It tends to begin at puberty, after pregnancy, after starting birth control pills, after hormone related surgery as hysterectomy or tubal ligation or around the onset of the menopause. In fact, it is not unusual for the PMS sufferer to confuse her symptoms with those of an early menopause.
*Lifting of symptoms (including headache) with pregnancy, especially in the second and third trimester.
*Heredity appears to be a factor although specific symptoms may differ between sisters or mother and daughters.
*There is often an aura of increased activity prior to the worse symptoms of PMS or migraines. At this time, the woman may clean the house, function with little sleep, and feel euphoric. This is followed by the PMS symptoms, migraine, fatigue, exhaustion, depression and the inability to function. Women typically feel “out of control” at this time and this can cause the signs and symptoms of depression.
The female hormone estrogen starts to rise after menstruation and peaks around mid-cycle (ovulation). It then rapidly drops only to slowly rise and then fall again in the time before menstruation. Estrogen hold fluid and with increasing estrogen comes fluid retention: many women report weight gains of five pounds premenstrually. Estrogen has a central neurologic effect: it can contribute to increase brain activity and even seizures. Estrogen can also contribute to retention of salt and a drop in blood sugar. PMS patients and migraineurs benefit from both salt and sugar restriction and a mild diuretic.
PMS and Migraine Diet
*Eat six small meals at regular three-hour intervals, high in complex carbohydrates and low in simple sugars. This helps to maintain a stead blood glucose level and avoid energy highs and lows.
*Substantially reduce and eliminate use of caffeine, alcohol, salt, fats, and simple sugars to reduce bloating, fatigue, tension and depression.
*Daily supplemental vitamins and minerals may be administered to relieve some PMS symptoms. A multivitamin with B6(100 mcg), B complex, magnesium (300mg), Vitamin E (400 IU) and vitamin C (1000 mg) may be recommended to alleviate irritability, fluid retention, joint aches, breast tenderness, anxiety, depression and fatigue. Be sure to check with your doctor before taking any medication for PMS.
*Exercise is helpful for PMS because it reduces stress and tension, acts as a mood elevator, provides a sense of well-being and improves blood circulation by increasing natural production of beta-endorphins. It is recommended, if your physician so advises, to exercise at least three times weekly for 20-30 minutes. Aerobics, walking, jogging, bicycling and swimming are a few of the suggested ways to exercise.
The Psychiatric Treatment of PMS
The problem with the treatment approach when used for more than a few cycles, is that it fails to address the underlying hormonal problems. So the result is the woman taking these medications may become sleepy, forgetful or not communicative. For this and other reasons, our primary approach has been hormonal.
Medical Treatments of PMS
These aqueous progesterone suppositories have been found effective. They are safe during pregnancy, as the placenta produces many more times progesterone than the pregnancy. They are safe in men too! In the 1940’s, progesterone was injected into men-- no side effects except they fell asleep! And since we use a slightly smaller dose to help women conceive, progesterone can be continued until well in the menopause.
Since 1979, Day and others have reported on the use of low dose danazol to control the worst PMS. Danazol is taken all month long and prevents the rise and fall of estrogen levels. In more than 10 medical articles, the success fate for controlling PMS in more than 80 percent. See article by Deeny. Although danazol has the side effects in some of acne and fluid retention, most are easily treated. Rarely has there been liver or bone changes with these dosages of medication. Some patients are so well controlled on hormonal therapy that they are able to discontinue the medications prescribed by the psychiatrist.
SSC Yen in 1985 showed that luprolide acetate, a long-acting agent for endometriosis, can rapidly eliminate the worse PMS symtpoms. Although luprolide is not usually used for these symptoms, it does confirm what these women have known for years--THE PAIN AND MOOD SWINGS ARE REAL!
So women need not feel that they are going crazy for these two weeks every month. They are experiencing an exaggeration of normal function. The physician can help the patient by first explaining the process, secondly using an anti-estrogenic hormonal medication to lower and stability the estrogen level, and lastly, using psychotropic medications for short periods of time.
PMS IS REAL-- AND THE PRESCRIPTION MEDICATION MUST ADDRESS THE WOMAN’S NEED AND THE UNDERLYING HORMONAL IMBALANCES.
The information in this newsletter does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice.
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Edward M. Lichten, M.D., P.C.