Life Cycle and Depression: PMS

What's the difference between a
terrorist and a woman with PMS?

You can reason with the terrorist.

This joke, along with many others about women with premenstrual syndrome (PMS), made the rounds several years ago. They illustrate the way that our society views premenstrual disorder (PMS).

PMS is a multi-faceted entity. Its milder forms present with signs and symptoms such as bloating and weight gain, cramping, tearfulness, irritability,increased appetite, decreased concentration, and sleep disturbance which begin approximately one week before the onset of a new menstrual cycle. Only one of these symptoms is necessary to make the diagnosis of PMS - as long as it begins during the luteal phase (after ovulation) of the menstrual cycle and ceases at the time of, or shortly after, onset of menses.

More severe premenstrual symptoms - such as depression, anxiety, mood swings, decreased interest in everday things, fatigue, low energy, overeating or food cravings, and feeling overwhelmed - indicate a diagnosis of premenstrual dysphoric disorder (PMDD). PMDD is severe enough that the symptoms interfere with a woman's relationships, work, and usual activities. She can't remember why she has just walked into a room, and she may forget important appointments. She may feel that she is no longer in control of her moods and her eating habits. In a more extreme case, she may become so depressed, during the luteal phase of her cycle, that she thinks about suicide.

As mentioned earlier PMS and PMDD symptoms occur in the luteal phase of the menstrual cycle - which is the last half of the cycle, following ovulation - when estrogen levels start to fall. Symptoms can last the entire few weeks or may last just a few days.

The same woman may have symptoms during some cycles, but not during others. The reason for this variability is unknown.

TREATMENT

From a purely medical viewpoint, PMS and PMDD are caused by hormonal changes. Though there are many experts who believe that premenstrual symptoms are due to a decrease in progesterone, there are just as many who believe that lowered estrogen levels are the cause. I fall into the latter category. As a psychiatrist, I have seen PMDD improve markedly with estrogen augmentation - and, conversely, I have seen it worsen with progesterone. My conclusions, however, are based solely on my own clinical observation.

Other biological factors figure into the the etiology of PMS and PMDD. Hypoglycemia can be a major player. As blood sugar gets too low, one can become irrational, cranky, and forgetful. For some women, dietary changes are helpful, and may include: reducing or eliminating tobacco, chocolate, caffeine, and alcohol intake; eating small, frequent meals as opposed to three large meals; B vitamins; decreasing salt intake; increasing calcium (1,000 - 1,200 mg/day) and magnesium (200 mg/day) intake.

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