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Winning the War on PMS

Got PMS?
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WebMD Feature

June 25, 2001 -- For 10 years, Los Angeles resident Vicky O'Toole experienced severe cramping, bloating, and nausea related to her period.

"Doctors kept telling me it was just PMS, but finally I learned I had endometriosis," a condition in which uterine tissue grows abnormally outside the uterus, she says. "I kept a careful list of all my symptoms for two months, and when they occurred. That convinced my doctor to listen to me. I hope other women will realize these symptoms can be a sign of significant illness. Discuss them seriously with your doctor, and be sure to get a thorough exam."

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Most nights, Karin Wacaser, 48, a public relations consultant in Dallas, sleeps soundly for about 10 hours. But three days before her period, like clockwork, Wacaser has intense insomnia, waking up every hour or two. "It's crazy," she says. "And frustrating. Sometimes I'll toss and turn for an hour until I can go back to sleep."At other times, Wacaser lies awake all night, finally falling asleep around 7 a.m. What is going on? "Each phase of the menstrual cycle has different effects on sleep," says...

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Alexander Shifrin, MD, agrees.

When patients arrive in his office saying they experience premenstrual syndrome, he first asks them to fill out a detailed questionnaire about their symptoms, including exactly what the symptoms feel like and when they occur. Then he takes a medical history, with a focus on previous obstetrical, gynecological, neurological, and psychological issues. Finally, he does a thorough physical exam.

"You want to rule out anatomical abnormalities such as fibroids and, of course, a disease such as endometriosis, which can masquerade as PMS. It is particularly important to look at the patient as a whole person, not just focus on gynecological symptoms," says Shifrin, an ob-gyn, associate director of residency programs at Long Island College Hospital in Brooklyn, and assistant clinical professor at the State University of New York-Brooklyn.

Look at Your Lifestyle

Once serious disease has been ruled out, the next step is to try some simple lifestyle changes. For many women, eliciting the relaxation response will control PMS, according to Alice Domar, PhD, director of the Mind/Body Center for Women's Health in Boston and author of Self-Nurture: Learning to Care for Yourself as Effectively as You Care for Everyone Else. Several different methods can be effective, she says, including progressive muscle relaxation, meditation, yoga, and guided imagery.

"Ten years ago, we did a randomized, controlled, prospective study of women with severe PMS," Domar says. Those who simply listened to a relaxation tape 20 minutes a day had a 57% reduction in both physical and psychological symptoms. In that study we used a tape that combines diaphragmatic breathing, breath-focused meditation, and mental images of walking along a mountain stream."

Many physicians believe dietary changes will do a great deal to lessen PMS symptoms. Steven Goldstein, MD, says severe salt restriction during the second half of the menstrual cycle is often helpful. It's not enough to stop using the saltshaker, he emphasizes. You have to check the labels on all sorts of prepared foods, and be aware of the high sodium content in many dishes when you eat out.

"I've had patients come back to me and say, 'I hate your guts. My diet is bland as hell -- but it does make a difference in my PMS symptoms,'" says Goldstein, professor of obstetrics and gynecology at New York University School of Medicine. He also recommends a moderate dose of water-soluble, time-release vitamin B-6.

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