A woman who suspects that she has premenstrual syndrome should consult a physician who treats PMS, or a counselor at a reputable PMS clinic. If a woman does not have access to a PMS specialist, she should visit her family doctor or gynecologist. An increasing number of physicians are making sincere efforts to understand the condition and a woman is very likely to find that her own physician can treat her with good judgment.

The medical approach, which includes hormonal therapy, is suggested for women who find that PMS is affecting the quality of their lives by creating symptoms that harm their personal relationships and prevent them from functioning normally. When the results of a woman’s blood tests are evaluated, a doctor might find a hormonal imbalance that may prompt him to advise the medical approach for a woman. There is also the possibility that a woman has begun self-treatment and found no relief. Her case might be so severe and her suffering so terrible that a doctor might start the medical approach even before all the blood tests are completed. Then, when the results of the blood tests are reported, he might modify the treatment accordingly. The decision to proceed with immediate medical treatment is often made when a doctor is faced with a health problem that he thinks might worsen during a wait for test results. For example, when a woman has a bladder infection, a doctor will begin treatment immediately if he judges that it would be detrimental to her health to wait for the urine culture and sensitivity test. When the urine analysis finally is reported, he might change her medication if test results show that she is not receiving the most effective therapy. In relation to PMS, the natural approach should be continued even if the medical treatment is altered. In fact, the natural approach should always be the first method chosen when an attempt to relieve PMS is made.

A woman should scrutinize the symptoms on her menstrual calendar and review the four categories¬PMT–A (anxiety, irritability, nervous tension), PMT–H (weight gain, abdominal bloating, fluid retention), PMT–C (food cravings, hypoglycemic symptoms), PMT–D (depression, withdrawal, lethargy, confusion, suicidal feelings)—to determine which division best describes her particular group of symptoms.

By understanding her individual syndrome, she will see that in her case certain treatments should be emphasized more than others. For example, if she feels that her problem is PMT—A (anxiety, irritability, nervous tension), methods of stress reduction may have greater priority than the lessening of her salt intake. For a woman with PMT—H (weight gain, abdominal bloating, fluid retention), salt reduction would be especially important. Still, no matter what form of premenstrual syndrome a woman is trying to control, all facets of the natural approach should be included in her treatment program. PMS is a systemic condition that can only be overcome with a mind/body treatment in which the entire woman is considered, not just individual symptoms.

However, it is important that the whole family understand whatever treatment is instituted and that they participate and help her stay on her course of recovery. The support of a woman’s loved ones is essential to her triumph over PMS.

Often families need counseling as much as women themselves. A husband must be able to adjust to his wife’s hormonal fluctuations and changing symptoms as she proceeds through the treatment process. He has probably already lived through emotionally chaotic times when he did not know what was happening. Now that he and she both realize that PMS is the problem, he must call upon his patience, sensitivity, and understanding to make the home environment as serene as possible, to reduce the stress and the guilt that can often intensify symptoms.

While a woman is trying to control and cure herself, her man’s loyalty and love are extremely important. It may also rest upon the husband/father to help his younger children gain insights into their mother’s health crisis and join in mutual supportiveness. Teenage girls should be approached a little differently than the youngsters. These young women might have menstrual cycles timed with their mother’s and they might have coinciding, hard-to-manage monthly symptoms, too. During this treatment interval, a mother and her teenage daughter should strive for a loving friendship to enrich their parent/child relationship and to help them conquer what may be a common problem that they share. A teenage boy may not be as attuned to a mother’s PMS as his teenage sister is, but he too should be informed and encouraged to show his concern and affection.

Once a woman accepts the knowledge of her condition, she must teach her loved ones about PMS through books such as this one, by arranging a private counseling session, or by inviting her family and friends to join her at a PMS support-group meeting, which a number of PMS clinics and women’s health organizations sponsor. If a woman’s family resists believing that her symptoms are physically based and real, there is no way that she is ever going to improve. Like women who have the postpartum blues, women with premenstrual syndrome need the support, understanding, and encouragement of their loved ones. It is the concern of family and friends that makes treatment effective.

If a woman suspects that her premenstrual syndrome is especially severe, she should visit a physician or a PMS adviser at a reputable PMS clinic. On the first appointment, she should bring her husband, or someone close to her, so that he or she will be involved in her discussion with the doctor and hear his evaluation of her condition and his advice about treatment.

During the initial consultation or a special counseling session, a partner, family member, or friend can ask questions that might not occur to you as a patient. For instance, a husband may want to know how your treatment is going to affect your home life, your lovemaking, and other areas of your partnership. A doctor should provide explanations that, while helping to untangle the complexities of this condition, serve as a bridge between two people.

When a woman and her family fully realize that she is suffering from PMS, she must begin to help herself by altering her lifestyle and changing habits and activities that might be heightening her symptoms. With awareness and an understanding of PMS, a woman can take many steps on her own to subdue this syndrome that at times may have seemed to overpower her.

It is hoped that through women’s networks and the distribution of educational material and books employers and employees will become informed about the many facets of PMS. Businesses should be encouraged to provide health information to all supervisors and workers about how PMS may affect women in the workplace. The goal is to create awareness among all people so that no one who is suffering is left untreated. A woman should not be considered a less than ideal worker if she has PMS; instead, she should be commended for recognizing her condition and seeking treatment.

Everyone should aim to eliminate premenstrual syndrome as an issue in the workplace. Women workers might advocate that every woman and man be informed about the symptoms and methods of overcoming the condition. Employers might even conduct educational seminars about PMS and offer referral services through their health care facilities. There is often more understanding given to alcoholics or men who are under pressure or short-tempered on hot summer days than there is offered to women who are enduring PMS, a hormonally based physical condition.

PMS, which can be aggravated by stress, is likely to intensify when women are in highly charged working environments. Women may even quit in frustration and lose jobs that they desperately need. Yet, if a woman received compassionate support from her colleagues in the workplace, she might steadily improve and PMS might become one of those incontestable issues. Once there were debates about whether women should be allowed to wear pants in the office, but today, what was once controversial is totally accepted. PMS must be accepted, understood, and treated. It is hoped that in the future, women in the workplace will no longer be discriminated against because they have this cyclic, hormonal condition.

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.