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."
Depression is a symptom that many women experience during their menstruating years. The key element that sets apart PMS-related depression from other forms of depression is the timing of symptoms. More than 150 different symptoms have been ascribed to PMS, but the hallmark of PMS-related problems is their occurrence during the two weeks prior to the onset of menstruation (around the time of ovulation). Women suffering from PMS-related depression report dramatic relief from their symptoms once...
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."