The Problem!

By definition PMS or premenstrual syndrome combines a group of over 150 various physical and emotional symptoms leading to monthly disarray. Although the cause of PMS remains uncertain, it is closely estimated that 70% to 90% of all women suffer the affliction on a monthly basis. To complicate matters more many women experience a condition called PMDD or Premenstrual Dysphoric Disorder. It would be safe to say that millions of individuals are touched daily by the negative consequences of this condition. So often, loved ones closely associated through marriage and intimate relationships fall victims to the anguish of PMS and PMDD. As with any disabling disorder, we must first understand the problem in its entirety. Only then can we acquire the necessary tools needed to cope with the environment this disorder creates. From the clinical stand point, here’s what you should know!

(The symptoms of PMDD resemble major depression. A woman with PMDD has her mood swings only in the one to two weeks before her menses. When we suspect PMDD, we often ask the woman to chart her moods for three months. This helps determine whether the mood shifts are confined to the premenstrual days. If depression or other mood shifts also occur in other phases of the cycle, we treat it as any depression, anxiety or bipolar disorder, using psychotherapy or medication.  If charting reveals that depression occurs only before menses, we can choose to treat with medication all month or we may decide to use medication only during the days before menses. The woman should be an active participant in making this decision. Full-cycle treatment is easier to remember. It does not require the same degree of charting and calendar watching. However, if the woman experiences medication side effects, or simply wants to minimize her medication use, she can take an antidepressant during the 10-14 days before her menses. The SSRIs (Prozac, Paxil, Zoloft and others) are the first-line antidepressants for premenstrual depression or irritability. They seem to work more rapidly for PMS mood symptoms than for regular major depression. If a woman has significant manic symptoms before her menses, she may need to take a mood stabilizer such as Lithium or Depakote during her entire cycle). Carol E. Watkins, Northern County Psychiatric associates

Understand the Source (Gentlemen, know your loved one’s biology)

The menstrual or reproductive cycle is the monthly process that prepares a woman’s body for a possible pregnancy. A normal cycle can last anywhere from 23 to 35 days, but the average length is 28 days. The menstrual cycle directly involves the ovaries, fallopian tubes, cervix, uterus and vagina, but the brain, pituitary gland and body chemicals called hormones also play an important part in this monthly event. Four female hormones trigger different events as your cycle progresses. Estrogen and progesterone are produced in your ovaries, while the pituitary gland at the base of your skull makes FSH (follicle-stimulating hormone) and LH (luteinizing hormone).

Day 1: Your Period

The first day of your period is considered Day 1 of your cycle. Unless pregnancy has occurred, this is when the thickened lining of the uterus and extra blood begin to be shed through the vaginal canal. It may not seem that way, but during the average period, a woman sheds only about 2 to 4 tablespoons of menstrual fluid. While most menstrual periods last from 3 to 5 days, a range of 2 to 7 days is also considered normal. Levels of the hormones estrogen and progesterone are low and you may experience bloating, breast tenderness and swelling, cramping and acne.

Days 1 to 13

Levels of estrogen increase and cause the lining of the uterus (endometrium) to grow and thicken in preparation for possible conception. In the ovaries, FSH (the follicle-stimulating hormone) causes eggs to develop and one dominant egg to mature.

Day 14: Ovulation

Around the middle of your cycle, the luteinizing hormone LH surges, the egg leaves the ovary and it travels into the fallopian tube where it can be fertilized.

Day 15-28: After Ovulation

During the second half of the menstrual cycle, the egg moves through the fallopian tube to the uterus. Progesterone levels rise and help prepare the endometrium for pregnancy. If the egg is fertilized by a sperm cell, the egg will attach itself to the uterine wall and the woman becomes pregnant. If the egg is not fertilized, estrogen and progesterone levels drop and the uterine lining breaks down and is shed. Your next period begins and the cycle starts again.

The End Result

When you look at the menstrual cycle, it’s easy to see what a central role hormones play. Before, during and after the females period, hormones can shift wildly, causing a wide variety of mood swings(mental conditions generally associated with depression; Moodiness, Irritability, Crying Spells, Feeling Anxious, Sadness, Feeling Tense, Disinterest in Daily Activities, Forgetfulness, Confusion, Difficulty Concentrating,  Anger/Aggression, Panic Attacks ,Fearfulness/Paranoia, Difficulty Handling Stress, Feeling Out of Control, Decreased Self-Esteem, Change in Sexual Desire, Withdrawal from Others.) These emotional symptoms have a biological basis, but as yet medical science has no solution! Treatments may vary from mild hormone supplements, vitamins, and exercise to intense anti-depressants and psychiatric counseling. Yet the success rate of all depend highly on the self awareness of the female being treated. It is only through her acceptance and her ability to view herself from a different perspective that treatment can provide some relief.

For more information on available treatment

 http://www.womenshealth.gov/index.htm

http://www.pms.com/

http://www.pms.org.uk/index.php?sid=sid2ac9f7b8a38601f066dbca12c3fca58a

http://www.baltimorepsych.com/index.htm

perspectives by:  Richard A. Bosco