Angry Woman

For some women, the 35 years between age 15 and 50 are a monthly nightmare. And anyone who cares about them knows to stay away as much as possible for 10 days each month. Some husbands mark their calendar in advance so they won’t be blindsided by the anger, irrational behavior, or prickly responses they know will almost certainly come. But premenstrual syndrome doesn’t have to drive you crazy. 

For the majority of women the emotional and physical changes that show up before each monthly menstrual cycle may be irritating, yet are tolerable. But for a small group of women those monthly premenstrual symptoms become downright debilitating. It affects their ability to work, their relationships with their husband and children, and their general ability to function in life. These desperate women fit the technical definition of premenstrual dysphoric disorder, or PMDD.

I had one patient whose husband brought her to see me out of desperation. “It’s like she’s two different people!” he complained. Another patient came in after discharge from the hospital for a “mental breakdown” triggered by premenstrual syndrome. Women this desperate are willing to do almost anything just to feel “normal” again.

A few medical facts about PMS and PMDD:

  1. It’s the monthly fluctuations in hormones that trigger the symptoms. Tests that measure the level of any given hormone on any given day are NOT helpful in making the diagnosis, or indicating what treatment may help.
  2. PMS/PMDD is only present when a woman has ovulatory menstrual cycles. Prior to menarche, during pregnancy, or after menopause the symptoms are not present.
  3. Psychological, environmental, and stress factors may not themselves trigger the symptoms, but they usually make an enormous difference in how severe the symptoms are.
  4. PMS/PMDD symptoms often become worse during a woman’s 30s and 40s, before resolving at the time of menopause.

One of the most important questions I ask when a woman presents with these symptoms is, “How do you feel about your period? Do you dread it or look forward to it?” A woman who has PMS/PMDD will usually look forward to the monthly relief that comes with menstruation.

What can you do?

Here are seven things to recommend that can make a difference. 

  1. Don’t be a victim! You may feel like your body and your mind are conspiring against you, but YOU can be in charge. Becoming educated – such as reading this right now – can empower you. And so can taking other lifestyle measures, getting professional help, and keeping a positive mental attitude.
  2. Eat healthy. Many women find that the swings in blood sugar that accompany processed carbohydrates may make their PMS symptoms even worse. Focus on eating fruits, vegetables, lean healthy protein, and unprocessed whole grains. Try eating more frequent small meals and snacks throughout the day. And stay away from salt!!
  3. Get some exercise. A good run may wipe out much of the distress PMS/PMDD brings on. A regular exercise program may be enough to keep some women off of prescription medication. This is something you can try on your own.
  4. Consider supplements. While science has a hard time documenting significant benefit, these are worth a try. I often suggest women use a trial of supplements to see if their particular symptoms respond. Consider these: evening primrose oil (3 times/day), magnesium/calcium (2 times/day), vitamin B6, or St John’s Wort. If you don’t see benefit within 1-2 months, move on.
  5. Get support. Talking with other girlfriends may give you ideas on better ways to manage your symptoms, and help you feel less alone. Just being honest with your husband with what you’re dealing with may help the relationship between you. Don’t suffer alone.
  6. Pay attention to stress. Look hard at the things in your life that cause you stress. Carefully evaluate them for any that you can decrease, especially during the time you have symptoms. Take extra measures to manage your stress during those days – music, time alone, Bible reading, etc.
  7. Get professional help. Many OB-Gyns and Reproductive Endocrinologists may be able to offer advice, eliminate other medical problems, and sometimes provide prescription treatments that can make a huge difference. Ask about oral contraceptives (helpful in only some women), SSRIs (may be very effective), and GnRH agonists (i.e. depo-Lupron – expensive injections, but may eliminate all symptoms.)

The point is, there ARE options. If this is you, take charge of your health in this arena. Do what it takes to get better. Even if you cannot eliminate every symptom, you should be able to significantly improve your quality of life and ability to function.

Your Turn: What is PMS like for you? Have you found something that helps you significantly?

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