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

PMS symptoms are surprisingly decreasing

Apollonie Sabatier, Vincent Vidal

I am at day 27 of my menstrual cycle.

This means it is really close to menstruation and when I should be experiencing more intense PMS symptoms, but I am seemingly not, as compared to say, about a week ago, or so, when I was feeling the effects of PMS quite keenly.

I still have some fluid retention, but markedly less than before and certainly not as bad as it was last week. My emotions seem to be quite level, without any major highs or lows or mood swings and my mind is clear and functioning really well. Almost like I don't have PMS at all!

I think it has a lot to do with the fact that I have been taking the Homeopathic medicine - General Tonic, Comb 12, which has the 12 tissue salts, that are supposed to be good for overall fatigue and exhaustion. This formula has a number of mineral salts in a specific ratio, which are thought to help the nervous system especially, but all the organs and tissues of the body to recover from any illness by helping it function in a more healthy way.

So while I have described the stress I have been exposed to recently, which has been unrelenting and which has precipitated the worse PMS symptoms of last week, since I have been taking the Comb 12 tissue salts, I have noticed a marked improvement in my symptoms, as I have outlined here. It's brilliant. I definitely did not want to go back to the horrendous PMS symptoms I used to get before, so this is fabulous to know that such a simple solution could be so effective in reducing symptoms.

I have also been exercising a bit more recently and have been diligently taking the iron supplement (as I am iron deficient) and I think those are also helping too.

The fluid retention I experience during PMS

Fluid retention is one of the factors of PMS that I experience basically every month, to a varying degree. It used to be much worse.

This month, I have experienced, for two days, very bad fluid retention. My stomach just jutted out so much (when it doesn't normally) and it felt uncomfortable when I was sitting down. Additionally, my breasts and nipples were so bloated with fluid that I looked like I was breastfeeding and besides which it hurt a lot!  I have had a little of fluid retention since that and before that, but not to that extent.

These are profound physical changes which would not occur at any other time than after  ovulation and just before the menstrual cycle starts.

I have been taking some homeopathic medicine which has helped a great deal to stop that much fluid retention and pain associated with it.

The homeopathic medicine I have been using is the General Tonic with the 12 tissue salts, which is for overall fatigue and exhaustion. They work on all the organs and tissues of the body to help it recover and function normally and obviously are an excellent way to prevent the fluid retention for me. I think because they work on the nervous system to make it more functional and to reduce any anxiety/stress, this helps me greatly.

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.

PMDD is not a mental disorder - it is just severe PMS

Vincent Van Gogh - Sorrow

 The condition PMDD (pre-menstrual dysphoric disorder) is a type of PMS which is much worse than regular PMS symptoms, especially in terms of the emotional symptoms.

According to a peer reviewed article reprinted by the American Academy of Physicians, they describe PMDD as:

In the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), PMDD is classified as “depressive disorder not otherwise specified” and emphasizes emotional and cognitive-behavioral symptoms.2  At least five of the 11 specified symptoms must be present for a diagnosis of PMDD (Table 1).¹  These symptoms should be limited to the luteal phase and should not represent amplification of preexisting depression, anxiety, or personality disorder. In addition, they must be confirmed prospectively by daily rating for at least two consecutive menstrual cycles. A symptom-free period during the follicular phase of the menstrual cycle is essential in differentiating PMDD from preexisting anxiety and mood disorders.

This means, PMDD has been given status as a serious mental disorder in the vein of major depression and bipolar disorder and in fact, some scientists believe that some women who experience PMDD are depressed, which is why anti-depressants are prescribed.

There are a number of experts who find fault with this diagnosis of PMDD as a mental disorder, notwithstanding that mental disorders have never been proved to exist (other than major mental illness) and that anti-depressants have been shown to do nothing for people with mild to moderate depression.

The problem as I see it with classifying PMDD as a mental disorder, is that it isnt. It is due to a number of factors being misaligned in the body (nutritional deficiencies, too much stress, no exercise, bad circulation) and these factors together can contribute to worsening of PMDD, yet when these issues are sorted out, the PMDD is completely reduced to manageable levels.

A recent study showed that 20% of women who did the diagnostic survey, met the criteria for PMDD, whereas 4.1% of men met the criteria for PMDD too. The authors of the study then suggested:

Therefore, these data suggest that PMDD may not be a premenstrual disorder per se. PMDD may instead reflect general cyclical changes in mood, and in women sometimes these changes occur during or near menstruation.

A number of other studies have criticised the assessment that PMDD is severe mental disorder, when it is clearly not.

If you have severe PMS-like symptoms that could be thought to be PMDD, check out my articles about what needs to be done and work with your natural health care practitioner to find a better way to manage your symptoms. You are not alone and you do not have to suffer with this problem. Just check with your doctor to make sure there is no underlying disorder (a real one).

References

1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, D.C.: American Psychiatric Association, 1994:715–8.
2. Bhatia SC and Bhatia S.  Diagnosis and Treatment of Premenstrual Dysphoric Disorder. Am Fam Physician. 2002 Oct 1;66(7):1239-1249.  Accessed 27 June 2010
3. Callaghana GM, Chacona C, Colesa C, Bottsa J, Larawaya S. An Empirical Evaluation of the Diagnostic Criteria for Premenstrual Dysphoric Disorder: Problems with Sex Specificity and Validity. Women & Therapy, Volume 32, Issue 1 January 2009 , pages 1 - 21 
4. Daw, J. Is PMDD Real? Monitor on Psychology, October 2002, Vol 33, No. 9 . Accessed 27 June 2010
5. Kissling, E. Women, Men and PMDD. Society for Menstrual Cycle Research, 15 October 2009.  Accessed 27 June 2010
6. Nash H, Chrisler JC. IS A LITTLE (PSYCHIATRIC) KNOWLEDGE A DANGEROUS THING? Psychology of Women Quarterly, Volume 21 Issue 2, Pages 315 - 322