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WHEN YOUR HORMONES TAKE CONTROL OF YOUR MIND, BODY AND SOUL (PART II)

I was planning an event with a very nice, professional woman.  When it was time to set a date, she was adamant about avoiding a particular time of the month. When I asked her why, I assumed she would say that she had a prior engagement or a trip.  Nope.  She said, “Girl, when I’m “PMSing”, you don’t want to be in my presence.”  At that point, I let her pick the date… because PMS (or Premenstrual Dysphoric Disorder, which we will discuss later) is very real…

In our last blog post, “When your Hormones take Control of your Mind, Body, and Soul (PART I),” we discussed the signs and symptoms of Premenstrual Syndrome (PMS).  In this blog post, we will talk about treatment options.  

*Lifestyle changes for emotional and physical symptoms:  For many women, lifestyle changes can help relieve PMS symptoms.  

  • Regular exercise is an important part of staying healthy, so it should be no surprise that it helps with PMS, too!  Regular exercise can help with symptoms like fatigue and mood changes.
  • Manage your stress levels by getting enough sleep and by practicing deep breathing, yoga, or other relaxation techniques.  Again, reducing stress is key to a happy, healthy life, and it helps with headaches, anxiety, and insomnia associated with PMS.
  • Eat better!  To limit bloating and water retention, eat smaller meals more often and avoid salty foods.  To help with overall health and PMS symptoms, make wiser food choices.  Make sure you are eating plenty of whole grains, fresh fruits and vegetables.  Avoid processed foods, alcohol, and caffeine.

*Medical treatments for emotional symptoms:  If lifestyle changes are not enough to help with your physical or emotional PMS symptoms, your doctor can help you decide if medication is right for you.

  • Antidepressants (SSRIs) can sometimes help regulate mood symptoms associated with PMS.  For some women with PMS, daily use might not be indicated.  Instead, this medication might only be needed for the two weeks before the start of your period.  Up to 60 to 70 percent of symptomatic women respond to an SSRI.  Of note, some women who do not respond to one SSRI medication may respond to a different SSRI, so if one SSRI doesn’t work for you, ask your doctor about switching to another one.
  • Hormonal contraceptives (Birth control pills) prevent ovulation and can help with some of the hormonal changes that trigger emotional symptoms.  When cyclic birth control does not adequately control symptoms, continuous birth control (ie- skipping the placebo pills) might provide more relief.
  • Combining SSRIs and Hormonal contraceptives.  If you try birth control pills, but you still have symptoms, consider adding an SSRI.
  • GnRH Agonists. If you have severe symptoms and you have not responded to or cannot tolerate SSRIs or birth control pills, ask your doctor about GnRH Agonists.  However, GnRH agonists should not be considered until you have first tried multiple SSRIs and a hormonal contraceptive with a shortened pill-free interval or continuous administration.

*Medical treatments for physical symptoms:

  • NSAIDs, or non-steroidal anti-inflammatory drugs (like Advil, Motrin IB, Aleve), can help with cramps, joint pain, and tender breasts.
  • Diuretics can help with bloating and water retention, but you should try to exercise more and reduce or eliminate salty foods before considering this type of medication.  Diuretics work by pushing excess water through your kidneys.
  • Hormonal contraceptives can also help with some physical symptoms, including acne flare-ups.
  • Supplements are sometimes beneficial.  Taking 1,200 mg of calcium a day might help reduce the physical and mood symptoms that are part of PMS. Taking magnesium supplements may also help reduce water retention (“bloating”), breast tenderness, and mood symptoms. One study has shown that vitamin E may help reduce symptoms of PMS.  With that being said, there are many additional dietary supplements that are advertised to help with PMS. Most of these products have either not been tested or have not been proved to be effective. It is important to talk with your health care provider before taking any PMS product or supplement. Taking excess amounts of them or taking them with some medications may be harmful.
  • Acupuncture might provide relief.

*Surgical Treatment:

Surgery. In very rare refractory cases with severe, disabling symptoms, removal of the ovaries (usually with removal of the uterus at the same time) is a last resort.  

When it’s not PMS — PMDD and other factors that may be causing symptoms similar to PMS

PMDD, or Premenstrual Dysphoric Disorder, is a severe form of PMS, in which monthly emotional and physical changes can seriously disrupt your work and damage your relationships.   If you are having severe symptoms or you are thinking of hurting yourself or someone else, seek medical care IMMEDIATELY.

You should never diagnose yourself with PMS or PMDD, as there may be underlying causes for your symptoms.  The emotional symptoms of PMS or PMDD can be confused with other mood disorders like depression or anxiety; or with physical problems like thyroid disorders, chronic fatigue syndrome, migraines, or irritable bowel syndrome.  

Bottom line: If you think you have PMS or PMDD, you need to see a doctor.

Getting ready for your appointment

Before you see your doctor for PMS or PMDD, try to track your symptoms and your cycle for at least two months prior to your appointment.  You can jot down some notes, or there are tons of free or paid apps you can download onto your smartphone (some are even compatible with your Apple Watch for super easy tracking).  These are great because they can also help you track your ovulation and even let you know when to expect your period.

Here are some popular apps, or you can just search for “period tracker” in your app store:

  • Clue
  • Period Tracker Deluxe
  • Life
  • Eve
  • Glow Ovulation

I don’t have any financial ties with the apps listed.  I just want you to help you feel better! 🙂 #DrNita

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