PMDD
(continued)

Diagnosis:

How do you know if you really have PMS or PMDD?  If you think you may, start keeping a PMS Symptom Diary. List the dates of your period, and which symptoms you have (and their severity) on the 10 days preceding, as well as following, your period. After tracking your symptoms for at least 2 cycles, bring this diary with you to consult your physician, along with a list of all medications you are taking (including prescriptions, over-the-counter medications, herbs, vitamins, and supplements). Your doctor will give you a complete history and physical exam to rule out other possibilities (such as hypothyroidism, hypoglycemia or depression); no specific physical findings or tests can confirm the diagnosis of PMS.

If you think you have PMS or PMDD, take Dr. Donnica's Decisionnaire™.  Check off all the points that apply to you and take this list with you when you consult your physician.

__ Do you have a stressful lifestyle?
__ Are you having relationship difficulties with your spouse, family members, or coworkers?
__ Would those who live or work with you say you have PMS?
__ Are you getting enough sleep (do you awake feeling refreshed?)?
__ Do you have regular eating habits and a balanced diet?
__ Do you get 20 minutes of aerobic exercise 3-4 times per week?
__ Do you smoke?
__ Do you drink alcoholic beverages?
__ Do you have more than two 8-ounce caffeinated beverages per day?
__ Is your diet high in red meat, salty foods or sugar?
__ Do you have food cravings in the 10 days before your period?
__ Do you have mood swings or crying jags in the 10 days before your period?
__ Do you feel bloated before your period?
__ Do you actually gain weight the few days before your period (that goes away when you've finished)?
__ Are you on birth control pills?

For general PMS relief, your doctor may recommend birth control pills or switching to another pill if you already take one. Other prescription medical interventions will depend upon the types of symptoms that most affect you. For example, if you are affected by bloating and weight gain, your doctor may prescribe a certain type of diuretic (sprionolactone) to help your body eliminate the excess water. If severe breast tenderness is a major complaint, birth control pills are often recommended. If this is insufficient, your doctor may prescribe a medication called bromocriptine to lower your levels of prolactin (a hormone linked to breast tenderness) or an androgen called Danazol®.  For dysmenorrhea (painful periods), prescription prostaglandin inhibitors such as Naprosyn® or Ponstel® can be very effective if over-the-counter non-steroidal anti-inflammatory drugs such as Motrin® or Advil® were not sufficient.

If you have severe PMS symptoms that interfere with your responsibilities or relationships, or if you tell your physician that you just feel out of control on those days, s/he may suggest that you try one of several prescription medications for PMDD symptoms. The choices are diverse and represent two major classes of anti-depressant medications: the selective serotonin reuptake inhibitors (SSRI's) and the tricyclic antidepressants. The SSRI's include medicines such as Prozac®, Effexor®, and Zoloft®.  They are generally well tolerated, work quickly, and reduce or eliminate disturbing emotional symptoms for many women, often at doses significantly lower than those required to treat depression.  A recent study showed that this type of antidepressant medication worked significantly better for the treatment of PMS than the tricyclics, although tricyclics (e.g. Pamelor®, Elavil®) have a role in treating women with severe insomnia or those with combined depression and PMS.

There are many advocates for "natural" progesterone therapy for PMS.  However, to date, multiple controlled clinical trials of progesterone in several dosage forms has failed to show any benefit for the treatment of physical or emotional symptoms of PMS. 

In addition to conventional therapies, many women with PMS report that they have been helped by modalities such as biofeedback, relaxation techniques, acupuncture, and massage.  My general approach to these types of therapies is that if you find something that works for you -- great.  For many patients, simple stress-reduction techniques such as taking long, hot baths or meditation are also helpful.

1. Discuss your situation with your physician. Work together to develop a comprehensive treatment plan. Follow it!
2. If you smoke, quit.
3. Practice stress management: many of the symptoms of PMS are unpredictable and emotionally draining. This can be very stressful and can exacerbate your condition.
4. Regular exercise may reduce your risk of PMS altogether; exercising once you have symptoms (even though you may not feel like it) will reduce the symptoms you experience for that cycle.
5. Take a daily, non-prescription multi-vitamin; discuss any other supplement needs with your physician.
6. Be sure to get an adequate daily intake of calcium (1,200 mg/day).
7. Eat a well balanced diet; don't skip meals.
8. Reduce intake of caffeine, alcohol, refined sugar, and salt.
9. Enlist the support and understanding of friends and loved ones.
10.  Try to get regular, sufficient sleep.

1. Should I be taking any dietary supplements?
2. Are there any other illnesses that could be causing my symptoms?
3. Should I be evaluated for other conditions such as low blood sugar, under-active thyroid, or depression?
4. Could this be related to any medications I might be taking (including birth control pills)?
5. Do I have PMS or PMDD?
6. Could my symptoms be related to perimenopause?
7. Am I a candidate for prescription drug therapy for this condition?
8. What medicines should I be taking to combat PMS?

Because doctors are not exactly sure what causes PMS or PMDD, there is currently no proven prevention. However, you may be able to alleviate some symptoms by leading a healthier lifestyle or changing other medications.

There is no cure, per se, for PMS other than menopause.  As discussed above, there are many strategies for effective management, and many interventions, which may decrease the symptoms significantly.  Whatever your choice of therapy, remember that you're not committed to that choice for life! The other good news about PMS unlike other recurrent conditions is that you won't have it for life:  PMS ends with menopause if it hasn't already disappeared after age 40 (although many of the symptoms of perimenopause are very similar to having PMS).  You and your physician will monitor your progress and your comfort level with your treatment plan.  If there are factors that change -- including your level of satisfaction -- discuss this with your physician.

The main thing that men need to know about PMS or PMDD is that jokes about PMS may be hazardous to your health!  In all seriousness, PMS is serious and PMDD is very serious.  Be supportive and understanding; but most of all, be thankful that you don't have to go through these symptoms every month.

Created: 11/28/2000  -  Donnica Moore, M.D.