Eating
your weight in chocolate and chips? Yelling at loved ones all week? Feeling
bloated and crampy? Uh, oh. Check your calendar. It might be that time of the
month.

It's estimated that 40 percent of women of childbearing age experience physical and emotional symptoms of premenstrual syndrome (PMS) that are severe enough to put a damper on daily routines and activities, reports the American College of Obstetricians and Gynecologists (ACOG). While PMS is a fact of life and the cause of much misery for many women, the exact cause of these monthly symptoms still is not completely understood. It appears that the hormones progesterone, estrogen and testosterone are involved, as well as serotonin, which is a brain chemical, according to the ACOG.

Try a 'carb' cure
Among the most aggravating physical changes that may occur with PMS are weight gain and food cravings, says Judith Wurtman, Ph.D., a research scientist at Massachusetts Institute of Technology who has done extensive study on brain
chemistry and PMS treatment.

Chocolate and chips are at the top of the list when women say they experience PMS food cravings. Food cravings associated with PMS are not the result of a nutritional deficiency, Wurtman says.

"It's a brain deficiency," she says. "It's a real phenomenon, provoked by changes in the brain when one's hormones are changing. The one chemical that drives all of this is serotonin. One way you can make serotonin is by eating carbohydrates.
But you don't have to eat chocolate or potato chips to do that any more than you
need to drink champagne to satisfy your thirst."

Marla Ahlgrimm, a registered pharmacist and co-author of the book Self-Help for
Premenstrual Syndrome, notes that women typically reach for high-fat or
sweet foods because they're a quick way to raise serotonin and endorphin levels.
"It's not the only way or the best way," she says. "A snack of complex
carbohydrates will do the same thing and may also allow the hormone progesterone to be metabolized fully."

"A lot of women crave sugar, salt, fatty foods. Sugary foods are a big one," agrees Susan M. Lark, M.D., a faculty member at Stanford University and author of
Premenstrual Syndrome Self-Help Book: A Woman's Guide to Feeling Good All
Month. "They eat the wrong foods; they eat Oreos or an ice cream bar or
chocolates. That just makes it worse." The result is a quick upswing in your
blood-sugar level; followed by a rapid decline - and then you're hungry
again.

It sounds counterintuitive but foods can help relieve PMS cravings, says Lark. When PMS cravings strike, she suggests fighting back with grains and beans, tuna on a piece of rye crisp or a rice cake.
"If you want to slow down absorption of the carbs, add a little oil like mayonnaise
or almond butter," Lark says. "That will really cut your craving."

The rule of halves
Perhaps the best way to cut down on PMS cravings is to change how you eat more than what you eat, Ahlgrimm says. By eating six small meals a day, you can help keep your blood sugar stable. "Adopting this meal plan often helps women avoid cravings," she says. "You're not eating more, just small amounts more often."There is no PMS diet, per se, but Ahlgrimm says she's found good results by following a "rule of halves" to manage cravings and other PMS symptoms.

For instance, breakfast can be a half-cup of whole grain cereal with berries and
low-fat milk. At mid-morning, have a handful of whole-grain crackers with carrot
or celery sticks or half a banana. At lunchtime, eat a half a sandwich made with
lean turkey on whole-wheat bread and half an apple. Two to three hours later,
snack on a half-cup of low-fat yogurt or cottage cheese, or the other half of
your sandwich, with the rest of your apple. "The rule of halves often helps alleviate women's concern that they will be eating too much and gaining weight," she says.

Supplemental cures
Because most women have problems meeting their nutritional needs through their diet, many experts recommend dietary supplements. Lark highly recommends taking 50 mg to 100 mg once or twice a day of a dietary supplement containing 5-HTP (5-hydroxy-L-tryptophan), an amino acid that the body converts to serotonin, along with 25 mg to 100 mg a day of a vitamin B complex to stabilize blood sugar and to help the 5-HTP conversion.

Considered a natural mood enhancer, 5-HTP is a supplement, not an FDA-approved medicine. It is derived from the seeds of the Griffonia simplicifolia, a West African medicinal plant.

Products
with 5-HTP are used as aids for insomnia, depression, obesity and in children
with attention deficit disorders.For women in perimenopause who have PMS symptoms, Ahlgrimm suggests looking into natural progesterone therapy, also called bioidentical progesterone. Available in non-prescription formats, bioidentical progesterone is a supplement "particularly effective in lessening premenstrual food cravings and irritability," she says.The calcium connectionWhen you have adequate levels of calcium and magnesium at the right ratio, chocolate
cravings may ease, Ahlgrimm says. Magnesium is important to regulate muscle
relaxation and blood sugar and to promote sound sleep - all particularly
important during PMS. Magnesium also increases calcium absorption in the body.

 

The benefits of calcium and magnesium for PMS are well supported. A study in The American Journal of Obstetrics and Gynecology reported that 1,200 mg a day of chewable calcium carbonate reduced symptoms of PMS by nearly 50 percent. A study in The Journal of Women's Health found that 200 mg a day of
magnesium reduced PMS fluid retention, breast tenderness and bloating by 40
percent.

Plain advice on PMS
Two important ways to reduce food cravings and weight gain is to follow the advice your grandmother probably gave you - drink six to eight glasses of water daily
and exercise regularly. "Often women with PMS avoid drinking an abundance of water because water retention is such a common PMS symptom. Drinking lots of water helps to flush the body out and actually reduces premenstrual bloating," explains Ahlgrimm. Staying physically active also helps reduce PMS symptoms. Not only does exercise burn calories but it's a natural stress-reducer and mood enhancer.

The American Academy of Family Physicians offers the following tips for controlling PMS:

Eat complex carbohydrates, such as whole grain breads, pasta and cereals,
fiber and protein. Cut back on sugar and fat.

Avoid salt for the last few days before your period to reduce bloating and fluid retention.

Cut back on caffeine to feel less tense and irritable and to ease PMS breast soreness.

Try eating up to six small meals a day instead of three larger ones.

Get moving with aerobic exercise. Work up to exercising 30 minutes, four to six times a week.

Get plenty of sleep - about eight hours a night.

Keep to a regular schedule of meals, bedtime and exercise.

If possible, try to schedule stressful events for the week after your period.  

 

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It's that time of the month and you're cranky, weepy, moody and even the dog hides when he sees you. You may think you've got PMS, but it may be PMDD.

PMDD? Yes, PMDD. Very simply, PMDD (premenstrual dysphoric disorder) is a severe form of PMS (premenstrual syndrome). PMDD symptoms typically go well beyond what are considered manageable or normal premenstrual symptoms. They occur the week before and disappear a few days after the onset of menstruation, medical experts say.

Those premenstrual days, though, can be agonizing. With both conditions, women can feel irritable, tense, emotional, sad and tired while experiencing roller-coaster mood swings. They also may have physical symptoms, such as bloating and breast tenderness. However, chances are with PMDD, you will have more severe mood swings and have trouble functioning at home or at the office.

"Women (who have PMDD) mostly find that they are pretty irritable and out of control," says Diane Dell, a gynecologist, obstetrician and psychiatrist at Duke University Medical Center in Durham, N.C., and a former president of the American Medical Women's Association.

Unless they have physical symptoms, most women with PMDD go to work even though they feel overwhelmed, Dell says. Even in the office, they may find it difficult keeping it all together. They are prone to angry outbursts and clashes with co-workers or family members.

Who has PMDD?

At least half of menstruating women experience PMS as opposed to 3 percent to 5 percent who experience PMDD, according to the American Psychiatric Association.

While most women have heard of PMS, a national survey of 500 women found that 84 percent were unaware of PMDD. The survey was commissioned by the Society for Women's Health Research.

Though the majority of women surveyed reported experiencing premenstrual symptoms in the previous year, 45 percent said they had never discussed PMS with their doctors. Even among women with strong or severe symptoms, 27 percent never talked with their physicians about the problem, despite the fact that their symptoms interfered with daily activities.

Some women wait for years to ask a doctor about premenstrual problems, says Jean Endicott, Ph.D., director of the Premenstrual Evaluation Unit at Columbia Presbyterian Medical Center. "They fear becoming the target of jokes or that seeking help is a sign of weakness,'' she says.

Keeping a diary

If you think you may have PMS or PMDD, speak with your health care provider and keep a diary of your symptoms, Dell says.

"A diary allows both the physician and a patient to make sure the symptoms are occurring just in premenstrum and not during other times in the menstrual cycle," Dell says. In that way, it can help a physician diagnose whether you have PMS, PMDD, or depression or another condition.

For some women, premenstrual symptoms can actually mask symptoms of depression. If the severe mood symptoms do not go away within a few days of menstruation, be sure to tell your health care provider. Also, if you already have a psychiatric disorder such as depression or even a medical disorder such as diabetes or asthma, you should know that PMS or PMDD could make it worse.

"Whatever you have, it's going to get worse premenstrually," Dell says.

Researchers aren't exactly sure what causes PMS or PMDD. One theory is that they are related to hormonal changes because of the menstrual cycle. Recent research has shown a connection between premenstrual symptoms and low levels of serotonin, a neurotransmitter in the brain.

What works for PMS and PMDD?

Making some lifestyle changes by getting regular aerobic exercise, reducing stress and cutting back on caffeine and carbohydrates may be helpful with PMS but don't really help much with PMDD, according to Dell.

If you have PMDD, she suggests talking to your health care provider about drug therapy. Treatment guidelines published by the American College of Obstetricians and Gynecologists recommend antidepressants known as selective serotonin reuptake inhibitors (SSRIs) as the initial drug of choice for the treatment of severe mood and physical premenstrual symptoms.

Sarafem® (fluoxetine hydrochloride) is the first and only drug approved by the U.S. Food and Drug Administration for both the mood swings and physical symptoms of PMDD. Sarafem has the same active ingredient as Prozac®, the best-known SSRI.

While most antidepressants take some time to take effect, Sarafem can be taken intermittently or continuously to treat PMDD and acts quickly, according to Dell. However, do not take Sarafem if you take another type of antidepressant called an MAO inhibitor.

Your PMDD checklist

Think about how you feel the week before your menstrual period. If you answer "yes" to some of the following questions, discuss your answers with your doctor to determine whether you have PMDD. Symptoms can vary from cycle to cycle, which is why it is a good idea to keep a daily record of both your mood and physical symptoms for two or three menstrual cycles to aid in discussions with your doctor.

Are you bothered by intense:

Irritability	Fatigue
Tension	Bloating
Sensitivity	Food cravings
Sadness	Breast tenderness
Feelings of being overwhelmed
Sudden mood changes for no reason

Do these symptoms cause problems with your:

Work	Social activities
School	Relationships (family, friends, etc.)

Do these problems go away soon after your period starts?

Yes

No