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 Annual 2014

Annual 2014


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PMS: It’s Not Just in Your Head

Severe symptoms may mean premenstrual dysphoric disorder, or PMDD, for the unluckiest women.

We’ve all heard the jokes about premenstrual syndrome, but for the many women who suffer symptoms that can include painful cramps, mood swings, and depression each month, PMS is no laughing matter.

According to the American College of Obstetricians and Gynecologists, at least 85 percent of women experience at least one symptom of premenstrual syndrome, the term used to describe the physical and emotional changes that occur in the days before a woman’s period. The symptoms can include irritability, anxiety or depression, diminished self-esteem, difficulty concentrating, sleep problems, appetite changes, low energy, bloating, headache, and breast swelling and tenderness.

Dr. Monica Kendrick, an obstetrician and gynecologist at Kaiser Permanente’s San Francisco Medical Center, says that treatment for PMS depends on the severity of a woman’s symptoms.

“For women with mild PMS symptoms, we typically start with lifestyle changes,” says Kendrick. “For women with greater functional impairment, we recommend lifestyle changes plus medications.”

Kendrick says the first line therapy for moderate to severe PMS mood swings is often having a doctor prescribe an antidepressant such as Zoloft or another selective serotonin reuptake inhibitor, or SSRI.

“This medication has shown to be effective in up to 70 percent of cases and can be taken during the vulnerable time of the cycle, which is two weeks leading up to menses, or on a daily basis,” Kendrick says. “Hormonal therapy, in the form of birth control pills, can also help with PMS symptoms such as hormonal swings and cramping.”

Hormonal therapy such as birth control pills suppresses ovulation, which in turn suppresses the hormonal fluctuations behind PMS. Some of the newer continuous birth control pills that offer women lighter periods or no periods also contain a form of progestin that has been shown to help with PMS symptoms.

“Birth control pills can be especially useful for women who have PMS and are also seeking contraception,” Kendrick says.

For women who prefer to treat PMS symptoms naturally, Kendrick says lifestyle measures such as regular exercise and stress-reduction techniques may help relieve symptoms of PMS.  

“For all healthy adults, we recommend moderate intensity exercise for 150 minutes a week,” Kendrick says.

Dr. Aimee Eyvazzadeh, a Bay Area an obstetrician and gynecologist and reproductive endocrinologist with offices in San Ramon, says that for about 3 percent to 8 percent of women, PMS symptoms are so severe that they are diagnosed with premenstrual dysphoric disorder, or PMDD, a more serious form of PMS. Women with PMDD find that the disorder not only interferes with their own health, but it also causes problems in their relationships at home and at work.

As an example of a possible case of PMDD, Eyvazzadeh cites the September suicide of former Bachelor star Gia Allemand. The reality show contestant’s mother appeared on the Dr. Phil show shortly after her daughter’s death and noted that Allemand’s intense PMS symptoms often clouded her thinking and may have contributed to her suicide.

“PMDD is a real medical disorder that causes extreme mood swings and depression,” Eyvazzadeh says.

In cases where PMDD is suspected, Eyvazzadeh refers patients to the Women’s Mood and Hormone Clinic at the medical center of the University of California, San Francisco, a unique psychiatric clinic designed to assess and treat women of all ages that experience disruption of mood, energy, anxiety, sexual function, and well-being due to hormonal influences on the brain.

While PMS and PMDD both have physical, mental, and emotional symptoms, in PMDD the emotional and mental symptoms are usually more prominent. In some cases, Eyvazzadeh has seen patients who were mistakenly diagnosed with PMDD but who actually have endometriosis, a gynecological condition that occurs when cells from the lining of the womb (uterus) grow in other areas of the body. This condition can lead to pain, irregular bleeding, and problems getting pregnant.

One reason that endometriosis can be hard to diagnose is that many women mistakenly believe that symptoms such as severe cramping, pain during or after sexual activity, heavy menstrual bleeding, and fatigue are a normal part of their monthly periods. Other women with endometriosis have milder symptoms and aren’t diagnosed with the condition until they have problems conceiving.

“Women may be told by their co-workers or family to snap out of it if they are feeling depressed, but PMS, PMDD, and endometriosis are very real conditions that can take a toll on woman’s job and relationships,” Eyvazzadeh says. “Women need to realize that if they feel this way that there is professional help available, and they don’t need to suffer in silence.”


Ease the Symptoms of PMS

Knowledge is Power. Diana Taylor, a professor at the UCSF School of Nursing, is a nationally renowned expert in women’s health and menstrual cycles. Her book Taking Back the Month: A Personalized Solution for Managing PMS and Enhancing Your Health has become a respected primer on various ways to handle PMS symptoms, from vitamins, to exercise, to anti-depressants, to cognitive behavioral therapy, to hormone therapy.

Increase Your Calcium Intake. In her book, Food Synergy: Unleash Hundreds of Powerful Healing Food Combinations to Fight Disease and Live Well, Contra Costa-based registered dietitian Elaine Magee discusses how research shows that PMS symptoms may be aggravated by a high-fat diet, and how foods rich in calcium can potentially cut symptoms in half. Some researchers suggest a daily calcium intake of around 1,200 milligrams a day, and Magee’s book and website, www.recipedoctor.com, offer recipes and ideas on how to increase calcium in your diet.

A Natural Approach. Often a combination of diet, medications, natural remedies and exercise is the solution to beating PMS symptoms. At the Gottfried Center for Integrative Medicine in Berkeley, Dr. Sara Gottfried, a board-certified gynecologist and author of The Hormone Cure: Reclaim Balance, Sleep, Sex Drive and Vitality Naturally with the Gottfried Protocol, helps women to balance their hormones and find natural solutions to alleviate their PMS symptoms.

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