PMS: It's Not All in Your Head

From the WebMD Archives

April 7, 2000 (Minneapolis) -- Are you irritable? Bloated? Depressed? Angry? Do you suffer from headaches, loss of libido, or mood swings? It could be premenstrual syndrome, or PMS -- then again, it might not be. The key to treating PMS, experts say, lies in correctly diagnosing it.

While research has estimated that PMS afflicts as many as eight out of 10 women, until recently, the syndrome was difficult to diagnose and treat, largely because physicians lacked the tools to properly diagnose it. Recently, both diagnosis and treatment of PMS have witnessed vast improvements.

Premenstrual symptoms are common and are considered a normal aspect of a woman's monthly cycle. However, proper diagnosis of PMS is important, particularly because its symptoms can mimic behavior disorders that include depression, aggression, and tension, Susan R. Johnson, MD, tells WebMD. Johnson, who is professor of obstetrics and gynecology at the University of Iowa in Iowa City, and colleague Ann J. Davis, MD, of Harvard Medical School, recently examined the latest evidence for effective diagnosis and treatment of PMS. Their findings were published in a special bulletin in the April issue of the journal Obstetrics and Gynecology.

While uncovering the causes of PMS can be challenging, Davis and Johnson say that diagnosis should be based on symptom diaries. "In the clinical setting, a simple system in which the woman records the dates of her menstrual periods and notes her symptoms on a daily basis is usually sufficient," they write. By reviewing three months of diary entries, doctors can make a diagnosis, and then determine which treatments might be most effective. "Clinicians can evaluate patients for other mood disorders, especially depression, and in some cases, prescribe drug therapy," she says.

Other effective treatments for PMS include supportive therapy, which has been used as a central component in PMS management, and informational counseling, which may relieve many anxieties while increasing the woman's sense of self-control. Relaxation therapy has also been shown to be effective, especially in women with the most severe symptoms. Carbohydrate-rich foods and some beverages are "a reasonable first-line approach in many patients," they write.

Some recent studies have shown calcium and magnesium to be effective in treating PMS, while other studies have found little usefulness in magnesium, vitamin E, vitamin B6, natural progesterone, or primrose oil.

Though oral contraceptives may improve physical symptoms of PMS, research results have not shown that they provide relief from mood swings. Davis and Johnson also found that certain antidepressant drugs, those called selective serotonin reuptake inhibitors, can be effective. But whichever treatment is used, "the approach should match the patient's individual needs," the authors write.

"Today, there is effective therapy for the majority of women with PMS," Johnson tells WebMD. Equally important, she says, is that they should realize that it's not all in their heads.

But perhaps the most encouraging message to arise from the swell of new data on PMS is that women should no longer accept a doctor saying, "There is nothing we can do," Johnson says.

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