Premenstrual Syndrome (PMS) is an umbrella term for troublesome mood and physical symptoms occurring before the onset of the monthly menstrual cycle. Most women have experienced at least some premenstrual or menstrual distress, but a certain percentage - probably 3 percent to 4 percent - have symptoms severe enough to disrupt their work, life, and relationships.
Fearing that their concerns will be dismissed or trivialized, many women fail to bring up the topic with their physicians. And often the doctors don't - or can't - spend the time to pinpoint the cause of the woman's suffering. Any menstruating woman is susceptible to PMS; neither youth nor approaching menopause is a guarantee of protection. Even so, it commonly takes women years, perhaps decades, to make the call for help.
Dr. Kimberly Yonkers is an associate professor in the Department of Psychiatry at the Yale University School of Medicine and heads the school's PMS and Perinatal Research Program. She and her team investigate medications approved by the FDA to treat PMS. Below, she shares one woman's story. (Some details have been altered to protect the patient's identity.)
Caitlin M. had it all: great husband, two young daughters, a high-powered job - and two decades of a PMS problem. But at 32, marriage, her relationship with her children, and her job were all at critical crossroads.
Caitlin owed her pale skin and red hair to her Irish ancestors, but nothing in her history suggested the roots of her short temper, extreme anxiety, increasingly negative attitude, feelings of being out of control and overwhelmed, and escalating irritability. Even though Caitlin was in the medical field - a nurse in a private surgical practice - for years she was reluctant to seek treatment. Unfortunately, this delay is fairly typical.
Many women have gotten so used to their PMS symptoms that they don't realize how severe they really are.
Often OB-GYNs allow only 15-20 minutes for a physical, and PMS can be a sensitive issue to bring up. At Yale's Center for PMS, we see too many in their 20s and 30s who feel that they should simply put up with their symptoms.
Caitlin's primary care doctor had never once asked her about her PMS. Finally, she brought the subject up herself. She was told: Get more exercise and reduce sugar, salt, and caffeine.
Initially this was good counsel. Studies also show that exercise can help reduce PMS symptoms; we suggest a goal of up to 30 minutes of exercise three to five times a week. The last thing a woman should do is immediately demand medication; she should first try some elementary lifestyle changes.
Many times, PMS can be helped by something as simple as giving up coffee. Fast food, cold cuts, potato chips, canned ham, canned soups, and condiments like catsup are so heavy in salt they may worsen water retention and promote swelling of hands and feet. Cutting out caffeine-heavy drinks like coffee, tea, colas, and chocolate may also reduce irritability and headaches.
But in Caitlin's case, nothing worked. Her main concern was that her daughters would be affected by her snappishness and short temper. She was trying to potty train her 2-year-old while meeting the emotional needs of a child just entering school. And throughout it all, she was feeling more and more like a bad mother, a bad wife, and a bad worker.
She was so keyed up and edgy that a chance remark from a colleague would appear to be an insult. And she found it increasingly hard to cope with the fact that many of the patients she cared for were extremely ill or dying. One day, Caitlin's husband cut an ad out of the paper for the Yale study of PMS. It was a loving way of telling her she needed help.
We screen very thoroughly before we admit anyone into one of our protocols. We evaluate for an extensive range of mood disorders, substance abuse, and other emotional and physical problems.
It's not always so easy to separate PMS from other mood disorders like depression. Some of the symptoms - pessimism, anger, short-temperedness, mood swings, and the like - overlap those of other problems.
A related and even more severe problem, Premenstrual Dysphoric Disorder (PMDD), affects about 3 percent to 9 percent of women. Symptoms are much worse than PMS, and these women may shut themselves off and feel that life it is not worth living.
Caitlin turned out to be a classic case of PMS, so she qualified for our six-month study. Had we found another reason for her problems, I might have referred her to a psychiatrist or a social worker, for family therapy or marriage counseling.
Along with 57 other women, she started taking a dose of 25 mg sertraline (Zoloft) daily for two weeks prior to her menses. This is less than what psychiatrists often prescribe for depression. We were trying to see if periodic doses of the medication would have the same effect as an ongoing dose.
We also tested two other antidepressants approved by the FDA for treating PMDD - fluoxetine (Prozac) and paroxetine (Paxil). And we asked all our subjects to keep a daily diary of their symptoms.
"This will help us rate the severity of PMS problems throughout a whole cycle," I told Caitlin. "We need to know when your emotional problems increase or dissipate. Timing is important."
Caitlin's husband, Brian, also kept a diary throughout the six-month trial. Once he saw the pattern, he could predict when Caitlin's bad days would occur.
"That way I could protect myself and our children from any potential setbacks during those days," says Brian. As the study progressed, however, he felt less defensive.
Caitlin had no side effects from the medication and slowly, her life began to turn around. Her symptoms tapered off, and she didn't want to stop the medication when the trial was over. By then Brian felt secure enough to throw away the "mood calendar." Caitlin told me the treatment had made her a better mother, wife, and better nurse. It gave her a new confidence and a sense of emotional stability. "I could listen again," she said. "I stopped snapping and I felt like my normal self."
For more information on PMS contact:
The National Women's Health Information Center: Premenstrual Syndrome
This article is for educational purposes only and is not intended as a substitute for medical advice. Please consult with a clinician to review any current symptoms and address your medical concerns.
