Premenstrual syndrome is an extremely individualized condition. The only experiences common to all sufferers are that the symptoms become more intense during the time between ovulation and menstruation, and that there is a symptom-free interval during each menstrual cycle. A woman with PMS should not expect to find another woman with symptoms quite like hers.

Since the syndrome varies from woman to woman, and even from month to month in the same woman, a PMS sufferer can gain the best understanding of her condition when she forms a health partnership with a doctor or a counselor who cares. A woman’s symptoms should be evaluated by the woman herself in collaboration with her doctor. There is always a chance that a physical problem other than premenstrual syndrome may be causing her to feel out of sorts.

If a doctor rules out other health problems and feels that PMS can be diagnosed from the facts that a woman has provided, he may decide against performing blood tests. Blood tests help to determine whether a hormonal imbalance is causing a woman’s premenstrual syndrome, and whether hormonal therapy may be appropriate. However, a physician may feel that a woman’s clinical symptoms alone provide enough information for him to make a tentative diagnosis and to initiate treatment.

A woman with PMS should always take her personal environment into consideration. Stress, as well as the calming effects of a woman’s close relationships, can make a difference in the way she is able to overcome her condition. Relatives and friends must be convinced of the seriousness of the syndrome.

Since many leading physicians now accept PMS as a reality, scientists and doctors are devoting more energy and time to learning how to treat the condition. With knowledge growing every day, there is no need for a woman to believe that there is no cure for this monthly malady. The next chapter will explain how you can begin to conquer PMS right now. You may start undertaking ways to treat your condition by yourself; in fact, self-treatment is sometimes all that is needed. If self-treatment does not seem effective, you can enter into consultation with a physician who can guide you to methods of overcoming the syndrome that has plagued you for so long.

Menopause can last anywhere from one year to several years, varying from one woman to another. It is the time when a woman may experience the well-known change-of-life symptoms such as hot flashes, hot flushes, dry skin, backaches, and other problems associated with declining estrogen levels. Some women, particularly women who have no obvious symptoms of menopause, might never know when menopause begins and ends because they are able to pass through this phase with little or only minimal discomfort.

During natural menopause, a woman should maintain a balance of calcium and phosphorus in her body. Certain foods such as cottage cheese, spinach, lobster, milk, and spaghetti contain varying quantities of these two minerals. In addition, approximately 2,600 milligrams of calcium carbonate tablets should be taken daily. Vitamin D, at least 400 units daily, will also aid in building calcium in the bones. Fluoride tablets help strengthen teeth and bones, and vitamin E-800 to 1,000 units daily—might also improve the bones. (If a woman chooses to take vitamin E, she should also add extra vitamin C to her regime since the body’s supply of vitamin C is somewhat depleted by vitamin E.) Since most refined foods have been robbed of vitamin B, a vitamin B-complex containing vitamin B, would complete this supplementary regimen. Thus, a proper diet, accompanied by a regimen of supplementary calcium, fluoride, and vitamins D, B, and possibly E and C, might help to lessen the severity of menopausal symptoms. After that, exercise to strengthen the bones is essential. Bicycling and walking are good, but swimming, an activity that never strains the bones, is especially advised.

However, subtle hormonal changes occur continuously in the course of a lifetime and a woman’s seeming transformations may have nothing to do with menopause. When a woman is in her forties, she may notice physical and psychological symptoms she did not experience in earlier years, but her hormonal levels may simply have changed to the point where symptoms have become apparent. It is well-known that PMS intensifies with age. Premenstrual syndrome is hardly ever seen among teenagers; the condition becomes more recognizable among women in their twenties, and it can be common as well as severe when women enter their late thirties and early forties.

Many women who experience menstrual irregularity, depression, and weight gain in their forties immediately assume that because they feel different they are in menopause. Usually these women are not premenopausal (or perimenopausal) but are suffering varying degrees of premenstrual syndrome.

Endometriosis is a disease in which the tissue that forms the endometrium, the lining of the uterus, spreads to the organs outside the womb. During the last half of a woman’s menstrual cycle—the two weeks that begin with ovulation and end in menstruation—the lining of the uterus grows rich in glandular tissue and blood vessels. Steadily, naturally, an emerging vascular layer turns the endometrium into a soft, spongy nest, a bed for a fertilized egg.

At this point, the endometrium exists to nurture fertilization, so if an egg is not fertilized, the body has no reason to keep this enriched lining. The cycle comes to an end. A woman’s uterus begins rhythmic contractions that disturb the blood supply to the uterine lining and cause the unused endometrium to detach from the womb and leave the body as menstrual blood.

When a woman is healthy, the regular contractions of her uterus push the uterine lining, the sloughed-off endometrium, first through the cervix, the mouth of the womb, and then through her vagina. But a woman who gets endometriosis often has a constricted uterus and a tight cervix, which do not let all the menstrual blood escape vaginally. Instead, a portion of the blood-filled uterine lining is pushed backward through the Fallopian tubes and sprayed out the tubes into the abdomen. Such a woman usually has a history of menstrual cramps.

Women with severe menstrual cramps have in their uterine linings high levels of prostaglandins, which can produce contractions similar to the ones experienced during labor and childbirth. In these women, the chances are great that their blindingly painful contractions will push the endometrial tissue into places where it can run wild. Endometrial tissue that has been flushed into the Fallopian tubes and sprayed out into a woman’s abdomen can implant itself on her ovaries, on the outside of her uterus, and in the cavity between the uterus and the rectum called the cul-de-sac. The tissue can begin to grow like a transplant on any of its new locations, and once that happens, endometriosis has begun. It should be noted, however, that even if a woman does not have severe cramps, tissue can still be pushed backward into the abdomen to cause endometriosis.

Each month, the fluctuation of the hormones estrogen and progesterone, which causes the production of the endometrium inside the uterus, is also having an effect on the endometriosis outside the uterus. The tissue thickens, bleeds, and, since it has no escape, spreads throughout the abdominal cavity. Sometimes, as it expands and bleeds, the tissue breaks off in cystic chunks that implant themselves elsewhere and cause severe abdominal pain.

An endometrical mass spreading behind a uterus can pull and tilt the womb backward. The tissue can move into the ovaries and Fallopian tubes, where it causes infertility. Endometriosis can even enter into the bowls and create bloody stools and pain during peristalsis, bowel movement. The tissue can penetrate the wall of the bladder, grow into the bladder, and then attack the kidneys and rectum. There have also been cases where endometriosis has spread to the lungs and—unbelievable as it may seem—the brain. If left untreated for years, endometrial tissue can even become cancerous.

However, if a woman can monitor her body for the distinct symptoms of the hidden disease, as endometriosis is called, she can possibly catch it at an early and curable stage. The symptoms of the disease include a possible painful ovulation two weeks before menstruation, severe cramps during menstruation, and a deep abdominal pain on one side or the other or an unspecific abdominal pain before or after menstruation. Other signs are infertility and pain during sexual intercourse. Many women who are infertile and are told they have no physical defects may, indeed, have endometriosis. During the course of the disease, pelvic pain caused by pressure on a woman’s organs and nerves slowly intensifies.

The main treatment used by knowledgeable doctors today involves a new, breakthrough drug called Danocrine (danazol), a synthetic derivative of the male hormone testosterone, which stops ovulation and gives a woman a “pelvic rest.” Danazol, which is the generic name for the drug, blocks the release of the brain hormones FSH and LH, which set the menstrual cycle in motion. A woman’s ovaries are not stimulated to release an egg, so there is no ovulation and estrogen and progesterone hormones do not increase. Estrogen and progesterone remain on the same steady low levels that are normally found after menstruation, a time when most women feel their best. When a woman does not ovulate and her female hormones do not fluctuate, there is no buildup of the endometrium and no chance for endometriosis to grow.

When a woman takes Danocrine-200-milligram tablets two, three, or four times daily, depending on her symptoms—for six to nine months, the endometrial tissue dies and, like all dead tissue, it is slowly reabsorbed by the body and disappears. Of course, a woman does not menstruate while she is on the medication.

Surgery should be performed as a treatment for endometriosis only when a woman has large masses that must be removed. However, a physician should not attempt extensive surgery with the goal of removing the disease totally, because he will never be able to succeed. A surgeon cannot remove every bit of endometriosis in a woman’s body. After surgery, the disease will come back. A woman’s doctor may tell her that he has cut, burned, or scraped all of the endometriosis away, but if a woman is not placed on danazol after her operation, the disease will always return. A woman ought to be placed on danazol therapy both before her operation, to reduce the endometrial growth, and after it, to prevent a reappearance of the disease.

It is possible that after her endometriosis has been treated a woman might develop mood swings and other symptoms of premenstrual syndrome. Fluctuation of the female hormones estrogen and progesterone affects both endometriosis and premenstrual syndrome. If a woman has—or has had endometriosis, she may also have a hormonal imbalance and may be more prone to PMS than a woman who has never been diagnosed as someone with the hidden disease. Once a woman has endured one form of menstrual distress, she should be on the alert for signs of others, even though they are technically not related.

Scientists recently discovered that cramp-causing, hormone-like substances called prostaglandins, which are produced in many tissues of the body, are significantly present in the lining of the uterus. Women who have excruciating menstrual cramps have been found to have more prostaglandins than women who were less bothered. PMS, on the other hand, is never mentioned in connection with prostaglandins. Premenstrual syndrome had been linked to hormonal imbalances and changes in interactions between brain hormones and the body’s neuroendocrine system.

Women who endure monthly attacks of cramps may sometimes have nausea, vomiting, diarrhea, headache, fatigue, and nervousness in addition. Headache, fatigue, and nervousness are occasionally observed as symptoms of premenstrual syndrome, but they are not accompanied by cramps. Also, while PMS sufferers notice symptoms anywhere from two to fourteen days before menstruation, women with menstrual cramps do not experience symptoms until their periods are about to begin.

During most of the monthly cycle, cramp-causing prostaglandins are held in check by the hormone progesterone. But just before menstruation, progesterone drops and prostaglandins rise. The cervix, the mouth of the womb from which the blood usually flows, tightens. The prostaglandins in the menstrual blood trapped within the womb are absorbed by the uterine muscles, released, reabsorbed, and released again in a circular fashion. It’s a vicious cycle. As the prostaglandins follow their circuit, the uterus contracts and cramps with ever more intensity, and until the menstrual blood flows from the vagina, taking with it the prostaglandins, women feel terrible. They are suffering very real pain, which is clinically called primary dysmenorrhea. (Secondary dysmenorrhea involves pain brought on by a pelvic disorder such as infection, endometriosis, fibroid tumors pressing on nerves, or a poorly placed IUD.

Scientists have discovered that aspirinlike medication prevents the body from releasing prostaglandins. In fact, a woman who has not tried aspirin might take two aspirins four times a day for two days before her period starts, and during the first days of her flow. Prostaglandins will not be blocked unless the aspirin, or any other antiprostaglandin drug, is taken before menstruation. Timing is essential for treatment.

Women have also been helped by Midol, the time-honored, over-the-counter, aspirinlike menstrual-pain reliever. Doctors did not know that Midol was actually lowering the prostaglandin level for women all these years, but indeed it does. Two Midol tablets four times a day, two days before and during the first few days of menstruation, have been known to provide positive changes. The antispasmodic in Midol also enhances its effects. Once again, it is essential for a woman to monitor her body for the arrival of her period, because she will have a much better chance for relief if she takes antiprostaglandin medicine prior to menstruation.

Three prescription drugs are approved by the FDA for dysmenorrhea—Motrin (ibuprofen), Anaprox (naproxen sodium), and Ponstel (mefenamic acid)—are often more effective than aspirin in blocking prostaglandins. One to two tablets of either drug, taken four times a day before menstruation and continued during the first few days of bleeding, should work their magic. Besides curbing cramps, these drugs also reduce menstrual flow. Since the drugs can irritate the stomach, they should be taken with some food, a cracker, or a glass of milk.

Each woman must listen to her body and decide how many tablets she needs for her own menstrual problem. She might even change her dosage from month to month. With the intense research that is currently being conducted, a variety of prescription and nonprescription antiprostaglandin medications will probably be available in the near future. For now, however, it is important to remember that Motrin, Anaprox, Ponstel, and Midol, taken properly, can act like wonder drugs. They can exorcise the menstrual pain that grips perfectly healthy women.

Recent studies on catecholamines show that scientists are investigating every possible angle in their search for the causes of premenstrual syndrome, but in the end, the studies are complicated and inconclusive. Scientists are understanding though, that not all symptoms of PMS can be related to fluid retention. Headache, abdominal bloating, and breast tenderness, for example, may result from specific, localized biological processes and not from systemic sources like catecholamines.

The catecholamines, which influence the involuntary nervous system, are not under a woman’s control. She can do very little to increase or decrease them, although they do release during stress and shock. Adrenalin, which is closely related to epinephrine, will incrase during nervousness, speed up the heart rate, and prepare the body to meet a challenge. However, it is not believed that the catecholamines, although they are involved in this process, have any significance in the development of PMS.

Since there was some belief that prolactin might be responsible for fluid retention, studies were done to determine whether edema could be reduced when prolactin was suppressed by the drug bromocriptine. Results have been very confusing since bromocriptine was found to be effective in some cases, ineffective in others, and occasionally even detrimental. Dues to these conflicting results, some researchers have suggested that prolactin may play more of a part in psychological symptoms, in the depression and mood swings of PMS, than fluid retention.

It was found that prolactin occasionally contributes to PMS symptoms. The serum prolactin level should always be obtained at the time a doctor request on the battery of hormonal blood tests that make up a routine PMS investigation. If a patient with PMS has high prolactin levels, treatment with bromocriptine should be started either daily or in a cyclic fashion when PMS symptoms appear.

Women with PMS are occasionally found to have high aldosterone levels in their urine. but the aldosterone levels in their blood are bnot significantly different from those of women without PMS. It has been theorized that the high level of urinary aldosterone may be linked to the fluctuation of the female hormones estrogen and progesterone, or may be result of stress, since anxiety affects aldosterone excretion. This latter fact about stress brings us back to the power of the brain.

Scientists are trying to understand and control action of dopamine, a brain chemical that reacts to stress, and indeed, may influence the flow of adrenal hormones. Studies have been done to investigate whether the drug bromocriptine, which inhibits dopamine, might lower aldosterone levels. Some of the research has shown bromocriptine to have an effect on the aldosterone system, but drugs is mainly considered for use in inhibiting the brain hormone prolactin.

Polycystic ovaries, or polycystic ovarian disease, is usually a hereditary condition that often can be part of the Stein-Leventhal syndrome. The ovaries become slightly enlarged and their surfaces develop hard shells. During a normal ovulation, an egg bursts from an ovary and enters a Fallopian tube. When a woman has polycystic ovarian disease, the hard outer shell surrounding her ovary imprisons the egg and a normal ovulation cannot occur. The egg can’t get out, it becomes a fluid-filled sac, a cyst inside the ovary. As more and more eggs are locked within the ovaries, more and more cysts develop and the overies become larger and larger. It is often difficult for a woman with plycystic ovarian disease to become pregnant, because she has an irregular ovulation pattern. About 10 to 15 percent of all women have polycystic ovarian disease. They live with irregular periods and they have exceptionally high amounts of estrogen produced by their larger ovaries.

Every woman produces estrogen, progesterone, testosterone, and if her ovaries enlarge, they will generate more of each hormone. Sometimes when hormonal imbalance is off, there is a high amount of male hormones, testosterone , secreted. The increased male hormone can cause the extra hairlines, which signals Stein-Leventhal syndrome. A woman with this syndrome will also have irregular bleeding, and she might be overweight due to her increased hormonal production.

The hormonal imbalance of Stein-Leventhal syndrome may also bring on symptoms of premenstrual syndrome. A woman with Stein-Leventhal syndrome already has a high estrogen level and a greater tendency toward breast cancer, but added weight resulting from the syndrome further increases the estrogen level in her body. Thus a woman with Stein-Leventhal syndrome has a hormonal imbalance accompanied by high salt content, fluid retention, and a greater tendency toward premenstrual syndrome.

If you have Stein-Leventhal syndrome, be alert to symptoms of premenstrual syndrome. Should you feel yourself suffering from PMS, try to understand the syndrome’s symptoms and make an effort to combat them with a natural approach. First attempt to keep your weight down by eating low-calorie foods and exercising, because an optimum body weight helps to counter a hormonal imbalance. If you treat yourself to a healthy diet, vitamins, and exercise but your symptoms continue to be debilitating and persistent, then you might consult a doctor you trust to find out if he thinks you need hormonal therapy.

Most women get over their postpartum depressions in a few days, but approximately 7 to 10 percent of new mothers have severe cases. Their depression seem to be long-term and their symptoms appear to be very similar to the anxiety-connected PMT-A symptoms of premenstrual syndrome.

The causes of the postpartum blues have never been exactly known. Different women suffer different degrees of depression after childbirth, depressions which completely unrelated to the length and intensity of their labors, In the past, it has said that the postpartum blues arrive because once a woman gives birth she has to relinquish her spot as the center of attention to her baby, and when her position changes, she becomes depressed. Other theories blame the blues on a combination of sudden physical changes that include fatigue after childbirth, anemia, and a shift in hormones that have been steady for nine months.

Often, awareness helps women deal with the onset of postpartum depression. Women who realize that they are suffering the well-known  after childbirth blues have felt better when they have modified their diets and exercised. Since the symptoms of postpartum blues are akin to the symptoms of premenstrual syndrome, they usually respond to similar treatments.

The fact is, however, that although no one can say definitely why, women who have postpartum depressions often become PMS sufferers. Both conditions are probably due to hormonal imbalance. Certainly the awareness, exercise, and diet consciousness that help women during the postpartum blues are also beneficial during premenstrual syndrome. But in PMS cases that are extremely severe, women have reportedly responded best to progesterone treatments. The female hormone progesterone, which is high and steady during pregnancy, probably is one reason why a woman might feel so good at the end of her nine months, just before her postpartum crash. There are times when progesterone seems emotionally return women to those pleasant, pre-childbirth days.

Doctors could have been advising PMS patients to take vitamin B-complex for the last forty years, but there was always some skepticism as to how effective vitamins really were. Still, studies have shown that some women who suffer from PMS do find relief with vitamin B-complex, especially if they accompany it with high doses of vitamin B₆.

The depressive symptoms that are associated with PMS, the fatigue and general malaise, have been shown to improve when a woman takes vitamin B_6. This vitamin disappears in cooking and canning and when foods such as whole-grain breads or cereals are stored for a long time or exposed to light. So, considering our modern food habits, it is no wonder that a woman often does not have enough B₆ in her body. And if for one reason or another she also has a hormonal imbalance, that imbalance may be increasing her already existing need for vitamin B₆.

Pregnant women who are expecting high progesterone levels sometimes have B6 deficiencies, which make them more susceptible to morning sickness. Women who are on a birth control pills with high estrogen and progesterone contents have complained of headaches, dizziness, fatigue, irritability, and depression, which are often alleviated by vitamin _B6. The said to affect PMS in the way it influences the release of the brain’s neurotransmitters, dopamine and serotonin.

The neurotransmitters are a person’s mood regulators. When a woman with PMS feels irrationally tense, depressed, irritable or agitated, she may have a vitamin B₆ deficiency that is decreasing the production of dopamine and serotonin. Her moods may become more stabilized after she takes this vitamin. She may even find that her food cravings and water retention subside.

Vitamin B₆ must be taken in high doses in combination with vitamin B-complex and other vitamins. If vitamin B₆ is taken alone, it might disturb the body’s intestinal microorganisms and cause other B vitamins to be excreted from, rather than absorbed into, a woman’s system.