Practical Practitioner

By: Pamela Egan, FNP-C CDE

PMS (Premenstrual Syndrome)

Dear Pam,

I began having heavy menstrual bleeding, cramping along with bloating, swelling and weight gain two weeks prior to my periods. I was prescribed birth control pills to lessen cramps and bleeding and Buspar for anxiety, all to no avail. What else can I do?

The diagnosis of Premenstrual Syndrome requires only one of the following symptoms: mild psychological discomfort, bloating and weight gain, breast tenderness, swelling of hands and feet, various aches and pains, poor concentration, sleep disturbance and change in appetite.

PMS is a condition that affects more than 80 percent of women in the United States but is undiagnosed by most practitioners. Severe depression, irritability and mood swings during the last two weeks of the menstrual cycle can interfere with a woman’s ability to function at home and work.

This interference can mean problems at work, loss of income, diminished parenting abilities and troubled relationships with spouses and other social acquaintances.

Conventional medicine has not agreed upon a specific cause for PMS, which makes clinicians skeptical about its existence. At the same time, PMS is presently so commonplace that it is considered to be a normal occurrence.

The treatment of PMS is directed toward eliminating symptoms. Practitioners prescribe anti-anxiety agents and anti-depressants for anxiety and depression, diuretics for water retention, naproxen for breast pain and menstrual cramps, and birth control pills for other symptoms such as bleeding.

The inadequacy of treatment, the skepticism about the existence for PMS and the lack of a feasible explanation for PMS symptoms by conventional medicine makes this a subject not readily discussed by most clinicians with their patients. There are some new and exciting answers on the horizon for women who suffer with PMS. A study was just released showing that a diet rich in calcium and vitamin D helps the body absorb calcium and may lower the risk of developing PMS in the first place.

In the study, the benefit was seen when women consumed the equivalent to about four servings per day of skim or low-fat milk, fortified orange juice or low-fat dairy foods such as yogurt, which added up to approximately 1,200 milligrams of calcium and 400 International Units of vitamin D each day.

It isn’t understood why calcium might help prevent PMS. One theory is that calcium affects the female hormone estrogen during the menstrual cycle. Hormone imbalance leads to PMS symptoms.

Estrogen and progesterone work best together in their proper ratio. The birth control pill frequently causes estrogen dominant state with a progesterone deficiency. Synthetic progestin in the pill is not the same hormone as natural progesterone.

Another natural treatment recommended for women with PMS is to apply a small amount of bio-identical progesterone to their skin on days 14 -25 of their menstrual cycle, which will alleviate PMS symptoms anxiety and depression, as well as many other symptoms. Bio-identical or natural progesterone has been proven safe for all ages. Wouldn’t this be easier than all those drugs? Creating balance is essential.

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