PMS is a real and severe health issue for many women

Women with premenstrual syndrome (PMS), from mild to very severe (and severe PMS is described as having premenstrual dysphoric disorder or PMDD) have a number of symptoms which compromise and adversely affect their quality of life and the level this is affected depends on the level of symptoms experiences - the worse the symptoms, the more adversely the quality of life is affected.

Scientists have been looking at women with PMS and have come to the conclusion that women who experience PMS symptoms experience lowered quality of life as they cannot function properly (whether it is in their relationships, work, social life) and this causes increased medical costs through more visits to doctors and subsequent lab test. It also causes indirect costs to employers through lowered productivity when a woman experiences severe PMS symptoms and cannot function or think as effectively as she normally does when not in PMS.

Women with severe PMS symptoms, especially the mental symptoms of anxiety, depression, anger can be so impaired in their ability to function normally (when not in the time of PMS), that it can cause an impairment in interpersonal or workplace functioning.

Interpersonal conflicts are common for women with PMS and that can cause a great deal of unnecessary stress in a workplace or for a woman's interpersonal relationships, which if not treated effectively and continues to escalate unabated, can mean those relationships cease to exist and employment may go on to be terminated. This of course, compounds the issue and it becomes a vicious circle.

Women with PMS must seek effective treatment for the symptoms of PMS in order to maintain a better quality of life and in order not to suffer the symptoms of this, often, debilitating condition.

Your doctor can use a Premenstrual Symptoms Screening Tool (PSST) to help you determine how PMS symptoms are affecting your life.

There are adequate (and natural) ways to control PMS (and even the condition known as PMDD).

References:

1.  Choi D, Lee DY, Lehert P, Lee IS, Kim SH, Dennerstein L. The impact of premenstrual symptoms on activities of daily life in Korean women. J Psychosom Obstet Gynaecol. 2010 Mar;31(1):10-5
2.  Freeman EW,  Sondheimer SJ. Premenstrual Dysphoric Disorder: Recognition and Treatment. Prim Care Companion J Clin Psychiatry. 2003; 5(1): 30–39. Accessed 8 July 2010
3. Mishell DR Jr. Premenstrual disorders: epidemiology and disease burden. Am J Manag Care. 2005 Dec;11(16 Suppl):S473-9. Accessed 8 July 2010
4. Pearlstein T, Steiner M. Premenstrual dysphoric disorder: burden of illness and treatment update. J Psychiatry Neurosci. 2008 Jul;33(4):291-301. Accessed 8 July 2010

Antidepressants and oral contraceptives - dont work for PMDD

A recent study² which reviewed data from studies dating from 1990 to 2008 to research those randomized, double-blind, placebo-controlled clinical trials of selective serotonin re-uptake inhibitors (SSRIs), a type of anti-depressant and combined oral contraceptives (COCs) to determine how much of an effect they had on women with symptoms of PMS and  symptoms of PMDD.

After reviewing the data, measurements and outcome of all of the large-scale studies, the authors of the review² noted that once the placebo effect was discounted, the actual results showed that the percentage of women who had a beneficial outcome from using SSRIs or COCs was not much more than the women who did not have any benefit from using these medications. In other words, women who used SSRIs or contracetives had the same level of PMS/PMDD symptoms as women who did not use the medications.

The authors of the review² also noted that around 40% of women with PMS/PMDD symptoms did not have a positive outcome from using the SSRIs medications - their symptoms did not improve. They also stated that treatment with COCs also does not substantially improve the symptoms in women with PMS/PMDD.

The authors of the review² suggested that "additional alternative targeted treatment modalities need to be developed" for more adequate treatment of PMS/PMDD than is currently available.

Other studies recently suggest that anti-depressants don't help people with mild to moderate depression and as depression can be one of the symptoms of severe PMS/PMDD, that suggests again, quite clearly, that anti-depressants are not going to help women with severe PMS/PMDD symptoms either.

A recent review^1,3 of a number of randomised studies of people using anti-depressants for depression found that there was little evidence that anti-depressants have an effect that is any different to a placebo for people with mild to moderate depression.  In other words, using anti-depressants and using placebos (no drug) have the same effect.

References:

1. Fournier JC, DeRubeis RJ et al. Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-analysis. JAMA. 2010;303(1):47-53. Accessed 8 July 2010
2. Halbreich U. Selective serotonin reuptake inhibitors and initial oral contraceptives for the treatment of PMDD: effective but not enough. CNS Spectr. 2008 Jul;13(7):566-72. Accessed 8 July 2010 
3. Silverman E. Antidepressants Don’t Help Mild Depression: Study. Pharmalot online. 5 January 2010. Accessed 8 July 2010

How much very severe PMS or PMDD used to affect me

Several years ago, I used to get excruciatingly bad PMS symptoms that could be described to be PMDD (which many experts do not believe exists and I agree).

I used to feel like I had a band of emotional pressure in my head, which would make me want to scream out loud - the pressure felt almost physical it was that bad. I just felt so awful and the intensity of the mood swings and emotions I experienced, were so terrible mostly because they were completely uncontrollable. I was so angry, my mood was totally volatile, I cried at the drop of a hat and felt very offended by anything anyone said to me, no matter how innocuous it was. I couldn't think properly, I couldn't sleep properly, felt very anxious and jittery, I was crying a lot, I felt resentful and angry at everyone and everything - I was very emotionally unbalanced. My mind seemed my worst enemy, with the intense negative emotions coming to a crazy crescendo just on the last day prior to menstruation. And when my periods arrived, it seemed the pressure valve inside my head was suddenly released and my brain could function normally again. I would no longer feel emotionally volatile once the bleeding started.

I went to see a doctor about it (my regular doctor wasn't available, so I saw a substitute) and he recommended I take the contraceptive pill all month long, for about one year, so that I didn't have any periods at all, thinking that would stop my very severe PMS symptoms! Total rubbish advice.  Artificially suppressing menstruation in that way is not healthy for the body and of course I did not take his advice.

When I was able to see my doctor, he recommended I see a gynaecologist to get further advice. The gynaecologist recommended I go on the contraceptive pill with a high level of oestrogen and progesterone. She also recommended anti-depressants and gave me a script for some to take in the two weeks prior to menstruation, but if I couldn't remember, then just to take it all month.

Again, rubbish advice!

I decided to do some research to find out exactly what causes PMS and how I could combat it to feel better again. I discovered that only with perseverance and hard work, I could reduce the symptoms and feel like a normal person. I used certain supplement, better diet choices, more exercise, massage and meditation, which when combined did greatly assist me. I also visited a Traditional Chinese Medicine practitioner who provided some acupuncture and that was a catalyst for positive changes.

Let me re-iterate:

PMDD is not a mental disorder and some experts are finally challenging its classification as a mental disorder when it is clearly tied into the menstrual cycle. If the symptoms occurred all month at the same level, then it would give some indication that it may be a mood disorder, but since it does not, it is clear that it is not.

There are alternatives to taking anti-depressants and the contraceptive pill, which are viable and better for your health overall.

PMS and PMDD Causes - Part 1: Nutritional Deficiencies

Researchers state that there is no real known reason why PMS (or PMDD) occurs in some women and not in others. Let me tell you what I think why PMS (and PMDD) occurs (part 1):

1. Nutritional deficiencies
Diet is fundamental to good health. That is the bottom line. If you do not get enough of natural, unprocessed foods, you are doing yourself a total disservice in terms of your health.

If your diet is basically composed of a great deal of processed foods (anything you buy from a store that you do no cook yourself) and you have a lack of fresh vegetables, fruits, wholegrains, seeds, nuts, oily fish such as salmon, trout, then your diet will be deficient in many vital nutrients (vitamins, minerals, amino acids). No amount of supplements will correct this - on one hand you are effectively ensuring your body becomes inflamed and deficient from various nutrients and on the other hand, you try to balance this with supplements, when you need the whole foods for your health.

You need to eat the following foods to maintain good health and to help your body get back to optimal health:

• Vegetables - 7 servings each day and at least 3 of these servings should be dark, green or dark red leafy vegetables (different types of lettuce, kale, spinach, sorrel, broccoli, watercress)
• Fruit - 5 servings each day and try to make sure you eat lots of brightly coloured or dark coloured fruits, such as blueberries, raspberries, dark purple grapes, acai berries, cherries
• Wholegrains - 3-5 servings each day and this means not just bread, but cereals, pasta and noodles too (just make sure they are not saturated with sugar)
  
• Legumes - 1-2 servings each day, this means all types of beans, such as lentils, kidney beans, chickpeas (garbanzo beans)
  
• Fish - 3-4 servings per week of the oily variety, such as salmon, trout, sardines, mackerel, but just make sure you buy the fish labelled as "wild" or "deep ocean" because these fish will have the most nutrients and are less likely to be tainted by heavy metals such as mercury and lead
• Meat - 3 servings per week and only organic, because the non-organic varieties have various chemicals and hormones injected into them, which interfere with your own hormone production and can exacerbate PMS and PMDD
• Nuts & seeds - 2-3 servings per day and try to use organic, raw nuts, unsalted as they provide the most nutrients

You need to eliminate the following foods (or at least severely restrict them):

• Alcohol - too much alcohol has a detrimental effect on the body and is not useful when you have PMS or PMDD
  
• Sugar - many women with PMS and PMDD experience variations in their blood glucose levels and an excess of sugar will make the blood sugar levels spike quickly and fall dramatically, which has a detrimental effect on insulin levels, which are pumped out at great levels to reduce blood glucose levels - eating less foods high in sugar and more natural foods will keep blood sugar levels on an even level and this means that there will be less of an issue prior to menstruation, including a curbing of sugar cravings, which many women also experience at PMS time
  
• Processed foods - any type of food that comes in a packet (other than raw nuts and seeds)
• Take-away foods - any type of meal you buy from a take-away store
• Salt - try to decrease it in your meal, use herbs and spices instead and try to use organic sea salt, which has more minerals in it than normal processed salt

The essential fatty acids in oily fish as well as the nuts and seeds are vital for women suffering from PMS and PMDD. Studies have shown that this essential nutrients is necessary as they are precursors of prostaglandins, which are hormone-like substances that affect women when they have PMS and PMDD. The B vitamins, which are abundant in good quality meat and wholegrains are necessary for women suffering this condition, as they help to reduce symptoms. The magnesium found in many whole foods is a natural muscle relaxant.