Menstrual Cramps, PMS, and other Monthly Challenges for Women
One very common consequence of normal menstrual periods is uterine cramping
or dysmenorrhea. While many women over 40 were told as teenagers
that this is "all in your head", we now know that this is really all in your
uterus: dysmenorrhea is a result of increased prostaglandin production immediately
before and during menses. Mild to moderate cramping is considered normal
and is usually easily treated with ibuprofen or other over-the-counter anti-inflammatory
medicines. Using oral contraceptives, using the contraceptive patch, and
practicing regular aerobic exercise may also reduce dysmenorrhea. Using an
intrauterine device (IUD) for contraception may increase menstrual cramping.
Women with moderate to severe menstrual cramping may have a medical problem
such as endometriosis or fibroids and should be evaluated by their physicians.
While dysmenorrhea is a very common menstrual symptom, it is not part of premenstrual
symdrome or PMS. PMS is a chronic, cyclic mood disorder distinguished by a
set of physical, psychological and emotional symptoms that affects approximately
four out of 10 women of childbearing age in the second half of their menstrual
cycle. While the exact cause of PMS symptoms is not known, many physicians
attribute them to fluctuations in female hormone levels or other bodily chemicals.
PMS is often the brunt of jokes and is rarely taken seriously, even by the women
who have it. It has been blamed for unpredictable, unexplainable, and unacceptable
behaviors in women from moodiness to murder. While up to four out of ten women
under 50 have reported symptoms of PMS, relatively few are actually affected
by its closely related, but much more severe condition, premenstrual dysphoric
disorder (PMDD).
PMS symptoms appear to be most troubling in women who smoke, have stressful
lives, rarely exercise, get insufficient sleep, or who have a poor diet. In
fact, PMS symptoms may be triggered or worsened by a high intake of caffeine,
alcohol, salt, red meat or sugary foods (especially chocolate). . .despite the
fact that many women with PMS have cravings for these substances (especially
chocolate). In some women, the use of oral contraceptives has worsened or produced
symptoms of PMS; in other women, however, starting or switching birth control
pills has reduced or eliminated PMS symptoms.
Women between ages 25 and 34 are more than twice as likely to experience PMS
than those between ages 35 and 44, although some women report that their PMS
symptoms increase in the perimenopausal years (the 2 to 10 years before menopause).
The good news is that PMS disappears once menopause is established, although
many women describe going through menopause as having "constant PMS"!
In recent years, there has been some controversy in the medical community about
the definition of PMS. This is because premenstrual discomfort is fairly
common among women of childbearing age, affecting about 3 out of 4 of all menstruating
women, making it quite "normal". However, fewer than 8 women out of 100 have
premenstrual symptoms that are severe enough to disrupt their personal relationships
or interfere with their normal daily activities. Some doctors feel that this
latter criterion is essential to make the diagnosis of "true PMS". Other physicians
feel that whether or not a woman has PMS or simply "menstrual discomfort" is
based upon the woman's subjective view of her own circumstances. If PMS symptoms
are significant enough to disrupt a woman's relationships or her normal daily
activities, treatment is available and should be considered.
Bloating is a common and uncomfortable menstrual symptom, with or without PMS.
In addition to menses, other bloating triggers include eating certain foods
(sugar, starches, salt); drinking too much alcohol (amount differs for different
women; usually just two or more drinks can do it); being sedentary; lengthy
travel or prolonged sitting for any reason; and certain medicines (e.g. hormone
replacement therapy, progesterone, antihistamines, aspirin, antidepressants,
and antibiotics). Bloating results from water retention, which in many women
is influenced by the hormonal changes of our menstrual cycle. Some women
document weight changes of 3-6 pounds before and after their cycle. This is
water weight. Ironically, treatment tips include drinking more water, not less,
as well as reducing sugar, starches and salt before and during menses. Exercise
may also help. Also, be sure to get an adequate calcium intake. Studies show
that women who aren't getting enough calcium are more likely to experience bloating
than women who do. Premenopausal women need 1,200 mg of calcium per day; postmenopausal
women need 1,500 mg/day if you have passed menopause. Getting an adequate amount
of daily calcium has also been shown to reduce other symptoms of PMS as well.
In some women, birth control pills may contribute to menstrual bloating, but
some pills may reduce bloating (e.g. Yasmin, which contains a progestin with
diuretic properties). Bloating is not always menstrually related, however. Women
who have bloating that lasts longer than their periods should consult their
physicians, particularly if they have other symptoms such as lower abdominal
pain or discomfort, back pain, weight loss and fatigue.
Birth control pills are often prescribed to treat menstrual irregularities,
regulate heavy periods, and even to reduce symptoms of dysmenorrhea or PMS. They
could have been called the "menstrual regulation pills" instead. However, birth
control pills are also associated with period problems of their own, especially
if a woman taking them misses pills or otherwise takes them incorrectly. Breakthrough
bleeding (unpredictable, irregular, light bleeding in mid cycle) is the most common
menstrual abnormality with "the Pill"; this often resolves without intervention
within 3 months. If it doesn't, a different Pill is often the solution. Post pill
amenorrhea is another complication of birth control pill usage. Of all of the
menstrual irregularities, no single condition causes women more stress than a
late period. The most common cause of "late" period is pregnancy; the second
most common cause is worrying about (or hoping to have) pregnancy. Other causes
of late periods are usually due to other stressors, although a late period may
be the first sign of amenorrhea. Losing (or gaining) a significant amount of weight
may also cause menstrual irregularities. Amenorrhea may also be caused by anorexia
(or other eating disorders), excessive exercise, chemotherapy or radiation, or
premature ovarian failure (menopause before the age of 40 for any reason).
Many women have headaches as part of their PMS symptoms, but having menstrual
migraine, a migraine headache occurring within the six days before menses, is
not normal. It is common, however: of the 18 million women estimated to be migraine
sufferers in the US, approximately two-thirds experience menstrual migraine.
While many women mistakenly associate these headaches as part of premenstrual
syndrome (PMS), they are migraines and may be effectively treated or prevented.
However, migraine headaches of this type are typically the most severe and least
likely to respond to treatment.
In some women, taking low-dose birth control
pills may reduce the frequency of menstrual migraine; however, some women
may actually experience an increased effect when they try this treatment.
Progestin-only birth control pills may also be helpful.
While there are numerous prescription and over-the-counter treatments for migraine,
prevention is often the best bet. Try to identify any triggers for your migraines
and avoid them. Practice healthy lifestyle habits such as getting adequate sleep
and balanced nutrition. Keep a headache diary and bring it with you to consult
a headache specialist who can review any medications you may have already tried
and offer some new options. If your medication is not helping despite taking
it according to the instructions, speak with your physician about the possibility
of taking a medicine prophylactically to prevent your migraines altogether.
Created: 6/27/2005 - Donnica Moore, M.D.
